Milestones on the Road to a Cure

On May 30 and 31, 2019, in Seattle, Washington, the National Psoriasis Foundation hosted its inaugural Cure Symposium. The symposium focused on the prevention of psoriatic disease and its comorbidities, precision medicine, and defining a road map toward a psoriasis cure. These topics are especially timely, given the remarkable revolution in our understanding of psoriatic disease through advances in genomics, informatics, immunology, molecular biology and the recent development of highly active psoriatic treatments.

The symposium brought together over 120 participants – including expert clinicians, scientists from academic institutions and industry, and trainees in the field of psoriatic disease – and provided a venue for collaboration and dissemination of scientific and clinical results.

Thursday, May 30

The symposium began with five lectures in a Thursday-afternoon session called “Prevention Strategies in Psoriatic Disease and Related Comorbidities.” Leaders in the field presented on the clinical management of psoriasis and psoriatic arthritis (PsA), mechanistic evidence for the increased risk of cardiovascular disease, new genetic findings linking psoriasis and type 2 diabetes, and the potential of leveraging the microbiome to reach a therapeutic end.

This session concluded with the symposium’s keynote address, “Immunologic Insights into Psoriasis,” delivered by Rachael A. Clark, M.D., Ph.D., of Harvard Medical School. Clark presented a translational overview of the role of cutaneous resident memory T cells in human skin diseases, including psoriasis. Her overview included potential strategies to selectively eliminate these cells, a process that may prevent recurring flares of the disease.

Friday, May 31

The first session on Friday highlighted efforts in precision medicine to achieve risk stratification and outcome prediction in psoriasis and PsA, which will hopefully help clinicians better manage their psoriatic disease patients. In addition, a presentation on efforts in biomarker development for both diagnosing PsA and tracking a therapeutic response highlighted the need for collaboration and standardization of study protocols to identify and validate clinically relevant biomarkers.

The second session that morning focused on current research efforts to find a cure for psoriasis and the knowledge gaps that remain to be filled. Industry efforts for developing safe and novel oral therapies were presented, as well as research aimed at determining the timing of irreversible immune pathology in the disease.

A highlight of the symposium on Friday morning was a cross-disciplinary session discussing lessons learned from cure efforts in other disease states: HIV, rheumatoid arthritis and cancer. These presentations emphasized the need for strong collaborations, early, aggressive therapy, and optimizing personalized medicine approaches.

Most of the afternoon was given over to interactive breakout groups that focused on identifying current gaps in our knowledge of psoriatic disease and discussing a road map for future psoriatic disease research. One key gap is the lack of a standard definition of remission or cure in psoriasis and PsA. A plan to develop a psoriasis remission and cure consensus – spearheaded by NPF – was reviewed to conclude the session.

What Comes Next?

Based on these productive discussions within the symposium, the next steps include:

1. Developing consensus definitions for psoriatic disease remission and cure
2. Inviting stakeholder groups to participate in creating detailed research plans
3. Developing better strategies to share patient cohorts, biopecimens and data
4. Supporting research to better understand the clinical and molecular heterogeneity of psoriasis and PsA
5. Establishing working groups and multi-institutional grant mechanisms to tackle specific challenges, including the design of clinical trials to investigate disease prevention, remission and milestones to a cure.

Overall, there was great optimism among the symposium participants that a concerted, interdisciplinary, and synergistic effort would result in significant therapeutic advances for psoriatic disease patients worldwide and move the field closer to a cure for psoriasis.

This story was based on reports by the 2019 Cure Symposium co-chairs (pictured above): Wilson Liao, M.D. (left), University of California, San Francisco, and Johann Gudjonsson, M.D., Ph.D., University of Michigan, Ann Arbor.