Tumor necrosis factor (TNF) inhibitor treatments emerged around 15 years ago as a new path in treating the nearly one-third of the psoriasis patients with psoriatic arthritis (PsA). TNF is a cytokine, or protein, that causes inflammation. TNF-inhibitors or blockers, the first class of biologics for psoriatic disease, offered much better outcomes than other treatments at the time.
Since, scores of studies and discoveries have pushed the envelope even further. A pair of researchers highlighted these advances in a review published in the May 2018 issue of Current Rheumatology Reports. “Novel therapeutics in psoriatic arthritis. What is in the pipeline?” provides an up-to-date glimpse into therapies people with PsA might expect in the future.
The list of options zeroes in on new ways to target PsA, looks at old targets in new ways and seeks to bring relief for those struggling to find an effective treatment.
“Fifteen years ago, if you had a relapse or any contraindications, we didn’t have a lot of options,” says Ofir Elalouf, M.D., a research fellow at the Department of Medicine, Division of Rheumatology, at the University of Toronto, Ontario, Canada, and co-author of the paper. “But today, the patient and the physician have many options for treatments.”
New targets, new methods
The paper shows that several recently approved therapies have the potential to complement or improve on older forms of treatment, especially when targeting cytokines other than TNF.
Biologics that block the pro-inflammatory cytokines interleukin-17 and interleukin-12/23 (IL-17 and IL-12/23) have been shown to fully clear the skin of psoriasis in up to 40 percent of people in some studies, a “dramatic” improvement, say the paper’s authors.
Future research aims to narrow the focus of these biologics. Drugs that single out IL-23, one of the proteins considered central to the cause of psoriasis, have shown promise in phase 2 clinical trials. Pre-clinical experiments reveal that targeting two sub-types of IL-17, IL-17A and IL-17F, is more effective than targeting either alone.
Clinical trials point to even more aspects of PsA to target, including new drugs that block janus kinase, an enzyme linked to psoriasis inflammation, and small molecule options that shut down T-cells that have gone haywire. Researchers are also actively investigating dual target antibodies and IL-6 blockers.
More data may mean better care
With so many treatment options for providers to choose from, Elalouf says the scientific community is still searching for the best timing and approaches for using different therapies.
More treatment options mean more opportunities for researchers to make discoveries, says the review’s co-author, Vinod Chandran, M.D., Ph.D., an associate professor at the Department of Medicine, Division of Rheumatology, at the University of Toronto. Treatment regimens that target different aspects of PsA at different times means more data will be generated, which gives researchers more information to work with.
Elalouf and Chandran see this data fueling the arrival of precision medicine. This combination of genetics and other techniques will offer patients a tailored prognosis and treatment plan, in PsA care – in as little as five years. Combining clinical data with current advances in the study of proteins, genetics, the microbiome and other areas could enable clinicians to provide treatments tailored for each individual patient.
“At the moment, we have a lot of types of treatments, which is great, but makes challenges for the doctor,” Chandran says. “One of the struggles now is saying, ‘OK, with so many options, what drug should we choose?’”
The treatment choices available in the future mean more options for relief.
Be a part of something big
The Corrona Psoriasis Registry and Corrona PsA Registry let you contribute valuable data about how your treatment is working. In turn, you can help improve outcomes for others with your disease. Learn more at corona.org.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.