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Yilmaz O, Pinto JP, Torres T. New and emerging oral therapies for psoriasis. Drugs Context 2024; 13:2024-5-6. [PMID: 39131603 PMCID: PMC11313207 DOI: 10.7573/dic.2024-5-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/04/2024] [Indexed: 08/13/2024] Open
Abstract
Psoriasis is a chronic inflammatory skin disease affecting 2-3% of the global population. Traditional systemic treatments, such as methotrexate, cyclosporine, acitretin and fumaric acid esters, have limited efficacy and are associated with significant adverse effects, necessitating regular monitoring and posing risks of long-term toxicity. Recent advancements have introduced biologic drugs that offer improved efficacy and safety profiles. However, their high cost and the inconvenience of parenteral administration limit their accessibility. Consequently, there is a growing interest in developing new, targeted oral therapies. Small molecules, such as phosphodiesterase 4 inhibitors (e.g. apremilast) and TYK2 inhibitor (e.g. deucravacitinib), have shown promising results with favourable safety profiles. Additionally, other novel oral agents targeting specific pathways, including IL-17, IL-23, TNF, S1PR1 and A3AR, are under investigation. These treatments aim to combine the efficacy of biologics with the convenience and accessibility of oral administration, addressing the limitations of current therapies. This narrative review synthesizes the emerging oral therapeutic agents for psoriasis, focusing on their mechanisms of action, stages of development and clinical trial results.
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Affiliation(s)
- Orhan Yilmaz
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan,
Canada
| | - João Pedro Pinto
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto,
Portugal
| | - Tiago Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto,
Portugal
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto,
Portugal
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2
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Holgersen N, Nielsen VW, Ring HC, Egeberg A, Thyssen JP, Gyldenløve M, Thomsen SF. Effectiveness, safety and drug survival of oral roflumilast for hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024. [PMID: 38949093 DOI: 10.1111/jdv.20222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Nikolaj Holgersen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Valdemar Wendelboe Nielsen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Gyldenløve
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hawkes JE, Al-Saedy M, Bouché N, Al-Saedy S, Drew DT, Song EJ. The Psoriasis Treatment Pipeline: An Overview and Update. Dermatol Clin 2024; 42:365-375. [PMID: 38796268 DOI: 10.1016/j.det.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Significant research advances in our understanding of psoriatic disease have led to the development of several highly selective, effective, and safe topical and systemic treatments. These treatments have led to unprecedented levels of disease clearance and control for most patients with psoriasis with cutaneous disease. However, there remains a need for improved treatments for those patients with recalcitrant disease, psoriatic arthritis, or nonplaque disease variants. Recently approved therapies and investigational products in ongoing clinical development programs that target IL-17A/F, IL-23, TYK2, PDE4, AhR or IL-36 cytokine signaling are improving the clinician's ability to care for a broader range of patients affected by psoriasis.
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Affiliation(s)
- Jason E Hawkes
- Department of Dermatology, Integrative Skin Science and Research, Pacific Skin Institute, 1495 River Park Drive, Sacramento, CA 95815, USA
| | - Miriam Al-Saedy
- Elson S. Floyd College of Medicine, 412 East Spokane Falls Boulevard, Spokane, WA 99202, USA
| | - Nicole Bouché
- Elson S. Floyd College of Medicine, 412 East Spokane Falls Boulevard, Spokane, WA 99202, USA
| | - Salsabeal Al-Saedy
- Elson S. Floyd College of Medicine, 412 East Spokane Falls Boulevard, Spokane, WA 99202, USA
| | - Delaney T Drew
- University Hospitals Regional Hospitals, 13207 Ravenna Road, Chardon, OH 44024, USA
| | - Eingun James Song
- Department of Dermatology, Frontier Dermatology, 15906 Mill Creek Boulevard #105, Mill Creek, WA 98012, USA.
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Mansilla-Polo M, Gimeno E, Morgado-Carrasco D. Topical and Oral Roflumilast in Dermatology: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:265-279. [PMID: 37709133 DOI: 10.1016/j.ad.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. In dermatology, topical roflumilast is authorized by the US Food and Drug Administration for the treatment of plaque psoriasis and mild to moderate seborrheic dermatitis. Several studies have described the off-label use of roflumilast in dermatology, including a randomized controlled trial showing its usefulness in the treatment of psoriasis; case reports and small series have also reported successful outcomes in hidradenitis suppurativa, recurrent oral aphthosis, nummular eczema, lichen planus, and Behçet disease. Roflumilast has a favorable safety profile, similar to that of apremilast, and it is considerably cheaper than new generation drugs and even some conventional immunosuppressants. We review the pharmacokinetics and pharmacodynamics of topical and oral roflumilast and discuss potential adverse effects and both approved and off-label uses in dermatology. Roflumilast is a promising agent to consider.
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Affiliation(s)
- M Mansilla-Polo
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, España
| | - E Gimeno
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, España.
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5
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Mansilla-Polo M, Gimeno E, Morgado-Carrasco D. [Translated aticle] Topical and Oral Roflumilast in Dermatology: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T265-T279. [PMID: 38224734 DOI: 10.1016/j.ad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 01/17/2024] Open
Abstract
Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. In dermatology, topical roflumilast is authorized by the US Food and Drug Administration for the treatment of plaque psoriasis and mild to moderate seborrheic dermatitis. Several studies have described the off-label use of roflumilast in dermatology, including a randomized controlled trial showing its usefulness in the treatment of psoriasis; case reports and small series have also reported successful outcomes in hidradenitis suppurativa, recurrent oral aphthosis, nummular eczema, lichen planus, and Behçet disease. Roflumilast has a favorable safety profile, similar to that of apremilast, and it is considerably cheaper than new generation drugs and even some conventional immunosuppressants. We review the pharmacokinetics and pharmacodynamics of topical and oral roflumilast and discuss potential adverse effects and both approved and off-label uses in dermatology. Roflumilast is a promising agent to consider.
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Affiliation(s)
- M Mansilla-Polo
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - E Gimeno
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, Spain.
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Salman HR, Alzubaidy AA, Abbas AH, Mohammad HA. Attenuated effects of topical vinpocetine in an imiquimod-induced mouse model of psoriasis. J Taibah Univ Med Sci 2024; 19:35-53. [PMID: 37868105 PMCID: PMC10585306 DOI: 10.1016/j.jtumed.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/11/2023] [Accepted: 09/09/2023] [Indexed: 10/24/2023] Open
Abstract
Psoriasis is an uncontrolled, long-lasting inflammatory dermatosis distinguished by thickened, erythematous, and flaky skin lesions. Massive amounts of inflammatory cytokines are produced when immune system imbalances are driven by genetic and environmental triggers. Vinpocetine (VNP), a man-made analogue of the compound vincamine found in the dwarf periwinkle herb, has robust anti-inflammatory, immunomodulatory, and anti-oxidative effects; alleviates the epidermal penetration of immune cells, such as eosinophils and neutrophils; and abolishes the generation of pro-inflammatory molecules. Objective This study was aimed at exploring the effects of long-term topical VNP, both alone and co-administered with clobetasol propionate, in an imiquimod-induced mouse model of psoriasiform dermatitis. Methods The study protocol consisted of 48 Swiss albino mice, randomly divided into six groups of eight mice each. In group I, petroleum jelly was administered daily for 8 days. In group II, imiquimod was administered topically at 62.5 mg daily for 8 days. In groups III, VI, V, and VI, 0.05% clobetasol propionate, 1% VNP, 3% VNP, and 3% VNP plus 0.05% clobetasol were administered topically for an additional 8 days after the induction, thus resulting in a total trial length of 16 days. Results Topical VNP at various doses alleviated the severity of imiquimod-induced psoriatic lesions-including erythema, silvery-white scaling, and thickening-and reversed the histopathological abnormalities. Moreover, imiquimod-exposed animals treated with VNP showed markedly diminished concentrations of inflammatory biomarkers, including tumour necrosis factor-α, interleukin (IL)-8, IL-17A, IL-23, IL-37, nuclear factor-kappa B (NF-κB), and transforming growth factor-β1. Conclusion This research provides new evidence that VNP, alone and in combination with clobetasol, may serve as a potential adjuvant for long-term management of autoimmune and autoinflammatory skin diseases, particularly psoriasis, by attenuating psoriatic lesion severity, suppressing cytokine generation, and limiting NF-κB-mediated inflammation.
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Affiliation(s)
- Hayder R. Salman
- Al-Mustaqbal University, College of Pharmacy, Department of Pharmacology, Hillah, Babylon, Iraq
- Al-Nahrain University, College of Medicine, Department of Pharmacology, Baghdad, Iraq
| | - Adeeb A. Alzubaidy
- University of Warith Al-Anbiyaa, College of Medicine, Department of Pharmacology, Karbala, Iraq
| | - Alaa H. Abbas
- Al-Nahrain University, College of Medicine, Department of Pharmacology, Baghdad, Iraq
| | - Hussein A. Mohammad
- University of Al-Qadisiyah, College of Pharmacy, Department of Pharmaceutics, Al Diwaniya, Al-Qadisiyah Province, Iraq
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Crowley EL, Gooderham MJ. Phosphodiesterase-4 Inhibition in the Management of Psoriasis. Pharmaceutics 2023; 16:23. [PMID: 38258034 PMCID: PMC10819567 DOI: 10.3390/pharmaceutics16010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/24/2024] Open
Abstract
Psoriasis is a common chronic immune-mediated disease with many comorbidities and impacts on quality of life. Among the treatments for psoriasis, phosphodiesterase-4 (PDE4) inhibitors are emerging with expanding options. PDE4 inhibitors play a pivotal role in the inflammatory cascade by degrading cyclic adenosine monophosphate (cAMP), contributing to pro-inflammatory mediator production. Apremilast, an oral PDE4 inhibitor, is approved for psoriasis. While effective, its adverse effects can limit its utility. Roflumilast, a topical PDE4 inhibitor, was also recently approved for psoriasis and shows promise in clinical trials. Crisaborole, a PDE4 inhibitor approved for atopic dermatitis, has also been studied in psoriasis. This review summarizes evidence from randomized clinical trials regarding the efficacy and safety of PDE4 inhibitors in psoriasis treatment. By highlighting their potential benefits and limitations, this review provides valuable insights for clinicians and researchers aiming to optimize psoriasis management.
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Affiliation(s)
- Erika L. Crowley
- Faculty of Medicine, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada;
| | - Melinda J. Gooderham
- SKiN Centre for Dermatology, 775 Monaghan Rd, Peterborough, ON K9J 5K2, Canada
- Probity Medical Research, 139 Union St E, Waterloo, ON N2J 1C4, Canada
- Department of Medicine, Queen’s University, 99 University Ave, Kingston, ON K7L 3N6, Canada
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Nicolas SE, Bear MD, Kanaan AO, Coman OA, Dima L. Roflumilast 0.3% Cream: a Phosphodiesterase 4 Inhibitor for the Treatment of Chronic Plaque Psoriasis. Am J Ther 2023; 30:e535-e542. [PMID: 37921681 DOI: 10.1097/mjt.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Plaque psoriasis is a chronic dermatologic autoimmune disease that affects adults and children. Roflumilast 0.3% cream is currently the only topical phosphodiesterase 4 inhibitor indicated for the treatment of plaque psoriasis in patients 12 years or older. PHARMACODYNAMICS AND PHARMACOKINETICS Roflumilast inhibits phosphodiesterase 4 inhibitor enzyme leading to the accumulation of cyclic adenosine monophosphate, which suppresses the inflammatory mediators interferon-γ and tumor necrosis factor-α. Roflumilast, applied once daily, reaches steady state by day 15 and has a half life of approximately 4 days in adults. Roflumilast undergoes extensive hepatic metabolism by cytochrome P450 enzymes and conjugation. Roflumilast is 99% bound to plasma proteins. CLINICAL TRIALS Roflumilast efficacy and safety were evaluated in the DERMIS-1 and DERMIS-2 clinical trials. These identically designed, double-blind, vehicle-controlled phase 3 trials randomized 881 patients to roflumilast 0.3% cream or vehicle, applied once daily for 8 weeks. In DERMIS-1, the Investigator Global Assessment success rate was 42.4% with roflumilast 0.3% cream compared with 6.1% with the vehicle (32.3%-46.9%; P <0.001). Similarly, in DERMIS-2, the Investigator Global Assessment success rate was 37.5% with roflumilast 0.3% cream compared with 6.9% with the vehicle (20.8%-36.9%; P <0.001). Of 881 participants, 1% discontinued treatment with roflumilast cream due to adverse reactions compared with 1.3% treated with vehicle. Urticaria at the application site (0.3%) was the most common adverse reaction that led to discontinuation of roflumilast. THERAPEUTIC ADVANCE To date, topical corticosteroids are the most commonly used agents to treat mild plaque psoriasis. Sensitive areas are often challenging to treat with existing topical therapy, including corticosteroids. Topical roflumilast has shown to be effective in treating sensitive areas, including skin folds, and may be an alternative to systemic therapy for some patients. The Food and Drug Administration approved topical roflumilast for the treatment of plaque psoriasis, including intertriginous areas, for patients 12 years or older.
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Affiliation(s)
- Samar E Nicolas
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Michael D Bear
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Abir O Kanaan
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Oana Andreia Coman
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; and
| | - Lorena Dima
- Transilvania University of Brasov, Romania, Faculty of Medicine, Department of Fundamental Disciplines and Clinical Prevention, Brasov, Romania
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