Research pipeline's best bets
With nearly 40 drugs for psoriasis and psoriatic arthritis in the research drug pipeline, we wanted to know the most exciting developments to watch for. Here's what three experts had to say:
Dr. Alice Gottlieb
Professor of Dermatology, Tufts University School of Medicine
Former member, National Psoriasis Foundation Medical Board
The "hottest" thing is that so many companies are developing new treatments for both psoriasis and psoriatic arthritis. When I started dermatologic practice, it was a battle to convince people that psoriasis was influenced by one's immune cells. Now many companies are producing multiple new drugs that modulate the immune system. There is so much hope for patients suffering with psoriasis and psoriatic arthritis.
- In the topical arena, look out for "JAK inhibitors," which are anti-inflammatory without the side effects of corticosteroids that are applied to the skin.
- For pills (orals), look out for apremilast and tofacitinib. Although they target different substances in the immune system, both are in the final stages of drug testing for approval for moderate to severe psoriasis. Apremilast is also being studied for psoriatic arthritis.
- For biologics, the newest biologic, Stelara, approved in 2009 for treating psoriasis, has just reported successful phase III clinical trials for psoriatic arthritis, confirming and extending phase II studies. Biologics targeting a cytokine called IL-17 or its receptor have reported high degrees of clearance in patients with moderate to severe psoriasis.
Dr. Andrew Blauvelt
Investigator, Oregon Medical Research Center
Member, National Psoriasis Foundation Medical Board
The coolest thing for me is that pipeline biologics for psoriasis are getting better and better: better efficacy, better safety profiles and more convenient. For example, new drugs that block the cytokine IL-17 protein are up to 80 percent effective at clearing psoriasis, appear to have great safety profiles and are usually prescribed in monthly doses. This is a very exciting time for patients.
Dr. Emanual Maverakis
Department of Dermatology, School of Medicine
University of California, Davis
The first use of biologics for the treatment of psoriasis occurred more than 10 years ago. Since then, an explosion of new injectable medications have been found to be effective in treatment of this disease. New oral medications, however, have lagged behind this wave of discovery. Once the mainstay of systemic treatments, oral medications such as acitretin, cyclosporine, methoxypsoralen and methotrexate have perhaps lost some of their luster in recent years.
It's especially exciting, therefore, that new classes of oral medications are finally emerging as potential treatment options for psoriasis. Oral drugs targeting the janus kinase (JAK) and other pathways are under development, showing great promise in clinical trials.
Although no new oral drug has yet obtained Food and Drug Administration approval for psoriasis, an FDA advisory committee has recommended approval of the drug tofacitinib (CP-690550) for adult patients with moderate to severe active rheumatoid arthritis. An oral drug that inhibits JAK, tofacitinib, is in phase III trials for psoriasis and psoriatic arthritis and is closer to approval than other promising oral drugs.