Potential future therapies for psoriasis

A pharmacoeconomic analysis of severe psoriasis therapy: a review of treatment choices and cost efficiency

INTRODUCTION

Psoriasis is a chronic, inflammatory disease afflicting 2% of the US population; it results in significant morbidity. The annual healthcare costs related to psoriasis are an estimated $11.3 billion and, with an expanding biologic market, an updated costs analysis is needed.

AREAS COVERED

Current treatments, including systemic agents (acitretin, cyclosporine, methotrexate), phototherapies and all available biologics (adalimumab, etanercept, infliximab, alefacept, ustekinumab) appropriate for severe psoriasis are described mechanistically and with regard to their efficacy, quality-of-life improvements and side effects. A cost-efficacy model considering US health-system-based annual costs, clinical and quality-of-life improvements was created. Reported Psoriasis Area and Severity Index improvement of 75% from baseline (PASI-75) scores, Dermatology Life Quality Index (DLQI) improvements and estimated costs of medications are described. Annual costs ranged from $1330 for methotrexate to $48,731 for high-dose etanercept. The lowest cost per achieving DLQI minimally important difference was from phototherapy; the highest was from alefacept. The lowest costs per patient achieving PASI-75 was from methotrexate and the highest was from alefacept.

EXPERT OPINION

Phototherapies and methotrexate offer high efficacy for their costs. Therapeutic approaches must be individualized for each patient given all considerations described.

ISA247: Quality of Life Results from a Phase II, Randomized, Placebo-Controlled Study

Background:

Psoriasis is a chronic skin condition that can negatively affect a patient's quality of life (QoL), often hindering social functioning. ISA247, a novel psoriatic agent, has shown clinical efficacy in moderate to severe psoriasis sufferers, but its effect on QoL is currently not reported.

Objective:

The objective of this study was to assess the effect of ISA247 on the QoL in patients with stable, plaque-type psoriasis.

Methods:

A phase II, randomized, double-blind, placebo-controlled, parallel-group, multicenter study assessed the effects of ISA247 doses of 0.5 mg/kg/d ( n = 77) or 1.5 mg/kg/d ( n = 83) compared with placebo ( n = 41) for 12 weeks. QoL was assessed using the Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI) scales.

Results:

ISA247 treatment (pooled groups) significantly improved QoL scores as assessed by both the DLQI and the PDI compared with those receiving placebo ( p < .05). Treatment with the higher dose of 1.5 mg/kg/d demonstrated a significantly greater response to many of the QoL scales compared with the 0.5 mg/kg/d group ( p < .05).

Conclusions:

ISA247 appears to improve the QoL while also providing effective treatment for chronic, moderate to severe, plaque-type psoriasis.

Treatment of psoriasis with adalimumab

BACKGROUND

Adalimumab is an anti-tumour necrosis factor agent of use in psoriatic arthritis.

AIM

The objective of this study was to assess the efficacy and safety of adalimumab in patients with plaque psoriasis unresponsive to previous therapies.

METHODS

We present nine patients with psoriasis and psoriatic arthropathy treated with adalimumab, including a woman with a history of breast cancer and a man with hepatitis C virus-related liver disease.

RESULTS

After 12 weeks, 66.6%, 55.5% and 11.1% of the patients showed a Psoriasis Assessment and Severity Index response of 50%, 75% and 90%, respectively. After 20 weeks, these levels had increased to 75%, 62.5% and 37.5%, respectively. After 12 weeks, the Psoriasis Global Assessment (PGA) score was clear or almost clear in 33.3% of the patients. By week 20, this clearance rate had almost doubled (62.5%). In two patients, the treatment was prolonged for 52 weeks, with a sustained response. One patient presented nonspecific colitis and died as a result of in-hospital pneumonia; any implication of adalimumab in the death is not clear. No other serious adverse effects were observed.

CONCLUSION

In this series adalimumab was found to be effective for psoriasis refractory to other treatments including infliximab and etanercept.

Immunobiologics in the treatment of psoriasis

The pathogenesis of various inflammatory cutaneous diseases such as psoriasis, atopic dermatitis and mycosis fungoides relies greatly on the abnormal function of T cells. Fundamental knowledge of the role of T cells in the cutaneous immune response has led to the development and production of biologic molecules designed to block T cell function at various steps, specifically activation (i.e. alefacept, efalizumab), trafficking into inflamed skin (i.e. efalizumab) and effector function under cytokine control (i.e. etanercept, infliximab, adalimumab, and anti-IL-12 antibody). We review the immune abnormalities and the role of T cells in psoriasis, and the recent biologic therapies, which share the common mission to hinder T cell activity in inflammatory diseases. An advantage from the preciseness of these biologic therapies is the potential limit of non-specific and potentially devastating organ toxicity, which commonly plagues other systemic therapies.