The Future of Treating Psoriatic Disease

The number of treatment options available for psoriasis (PsO) and psoriatic arthritis (PsA) has significantly increased in the past decade and can provide patients with multiple modalities for efficacious symptom treatment, according to a continuing education symposium presented at the Asembia Specialty Pharmacy Summit 2018. This symposium provided an update on current and emerging treatments for PsO and PsA as well as cost-effective methods and management strategies.

After a review of the incidence of PsO, the presentation provided an overview of the associated economic burden, estimated at $135 billion annually and driven primarily by medical appointments and treatments, reduced work productivity, treatment of comorbidities, and reduced quality of life. Alongside the economic burden, the presentation reviewed the psychosocial burdens of PsO, including depression, anxiety, sleep disorders, suicidal ideation, occupational productivity disruptions, and pain.

Next, the presentation provided a refresher of PsO types, body coverage and severity ratings, and associated comorbidities, particularly cardiovascular and metabolic conditions. Recent clinical trial data were provided for several novel therapies, including the anti—IL-17A drug ixekizumab; a Janus kinase inhibitor, tofacitinib; the anti–IL-23p19 drugs guselkumab and risankizumab; an anti–IL-6, clazakizumab; and a selectin, neihulizumab.

Notably, the phase 3 UNCOVER-3 extension study compared the use of ixekizumab, etanercept, and placebo among 1346 patients with PsO. By week 12 of treatment, 87.3% and 84.2% of patients receiving ixekizumab every 2 and 4 weeks, respectively, achieved a Psoriasis Area and Severity Index score of 75, compared with only 53.4% and 7.3% of those receiving etanercept and placebo, respectively.

Furthermore, ixekizumab administered every 4 weeks was $28,681 less expensive than biweekly etanercept and $21,375 less expensive than ixekizumab administered every 2 weeks. Guselkumab, an agent approved in the fall of 2017 for mild to moderate PsO, was compared with adalimumab in the phase 3 VOYAGE 1 trial. By week 16 of treatment, the percentage of patients who achieved a score of absence of disease or very mild disease and ≥2 grade improvement in the scalp-specific Investigator’s Global Assessment score was 83.4% for guselkumab, 70.3% for adalimumab, and 14.5% for placebo, with guselkumab achieving significance (P <.01) in all comparisons.