Psoriasis is an autoimmune disorder. In patients with the skin and scalp form of the disease, called plaque psoriasis, the body produces too many skin cells. This results in areas of thick skin that appear as silver-white patches. Psoriatic arthritis attacks the joints, causing pain and joint damage.
The array of new medications is confusing and will take the patient working closely with his or her rheumatologist to find the best drug with the fewest side effects.
New Treatments Currently Available
According to the National Psoriasis Foundation, there are 18 injectable drugs currently in development. Only one, Cosentyx (secukinumab) is now available to patients. Another nine are in Phase III trials, the stage just before FDA approval and introduction to the marketplace. There are 12 oral treatments. Only Otezla (apremilast) is now available for prescription. There are 15 topical treatments that are applied directly to the plaques. One, Enstilar (LEO 90100) foam, is available now.
Cosentyx (secukinumab) is manufactured by Novartis Pharmaceuticals Corporation and was approved for patients’ use in January 2015. Secukinumab, the active ingredient, is an antibody. This antibody binds to a protein, called interleukin (IL)-17A, that helps cause the underlying inflammation. The medication bind to the protein and so prevents the plaque psoriasis process from starting.
Like all systemic anti-psoriasis drugs, there is the risk of side effects. These are severe allergic reactions, the risk of infections due to the expected actions of the drug itself. Most commonly, the reactions include upper respiratory infections and diarrhea.
Otezla (apremilast) is manufactured by Celgene Corporation and is an anti-inflammatory (phosphodiesterase-4 inhibitor) which addresses both plaque psoriasis and psoriatic arthritis. Two pills are taken daily. The patient is introduced to the drug with a 28-day starter pack that gradually increases the amount of the drug.
Otezla has some possibly significant side effects. Nausea, loss of appetite and diarrhea can account for a weight loss of up to 10 percent. Depression is also an expected outcome for some patients.
Enstilar (LEO 90100), manufactured by LEO Pharma, is a foam product that is applied directly to plaque psoriasis scales, both on the skin and the scalp. The foam contains steroids and a Vitamin D analog. The foam is applied once daily for up to four weeks.
Side effects occurred in fewer than 1 percent of the patients and included itching, infection of hair follicles, and the psoriasis worsening.
Treatments Under Development
The drugs being developed now and in the near future build on these and similar discoveries about what works with this chronic and relapsing disease. Some of these developments are discoveries about the roles diet, exercise, complementary medicine and stress play in flare-ups.
Physicians, patients and families can visit and register with the National Psoriasis Foundation. This organization provides education, support for research and the latest information about treatment developments.
The important thing for physicians and patients to remember is that new discoveries are being made each day and the future for remission has never been brighter.