Although psoriasis is primarily a disease of the skin, its effects often go well beyond skin deep.
The disease, which is considered to be autoimmune, can be very difficult to live with. Its most common form causes white, scaly patches, which are itchy, unsightly and can cover large areas of the body. Although uncommon, it can be so debilitating that people who are afflicted have higher rates of depression and suicide.
But, there may be a major breakthrough around the corner. In two phase III trials, an antibody (which is called secukinumab) provided unprecedented improvement of both the rate and magnitude of response.
This is made clear by co-author Mark Lebwohl, MD, the chairman of the department of dermatology at Icahn School of Medicine at Mount Sinai Hospital in New York City. Referring to a clinical trial called ERASURE, he said, "These are the best results of any of the treatments currently available for psoriasis," said Dr. Lebwohl. "The availability of this drug will dramatically change the treatment of psoriasis."
He s not kidding. The ERASURE trial resulted in improvements of 75 percent, as measured by the Psoriasis Area and Severity Index (PASI 75). In 3 months, 81.6 percent of patients who got a higher dose of the drug attained PASI 75. The response rate of patients treated with a lower dose was still an impressive 72 percent. The placebo effect ( that is, those treated with an inactive compound) was less than 5 percent.
As with any drug that modulates the immune system, susceptibility to infection is always a concern. For example, etanercept (Enbrel), although it works by a different mechanism, may be the best current treatment for psoriasis. It also modulates the immune system. Its warning label contains quite a number of possible side effects, many of which involve worsening of infections.
So, it is not surprising that incidence of infections most commonly yeast with secukinumab were comparable: 27-31 percent for secukinumab vs. 25 percent for Enbrel. However, the infection rate for the placebo group was more than 19 percent, so these results need to be verified in longer term safety studies.
Nonetheless, this new drug offers great hope for the 7.5 million Americans who suffer from this very unpleasant condition.
ACSH s Dr. Gil Ross says, Psoriasis when extensive is truly a life-altering condition. So it is very good news to hear of this potential major advance in its treatment. Still, these are preliminary data and larger, longer trials are needed, and are underway as we speak. Rates of infection will have to be carefully monitored.