SPONSORED FEATURE
Understanding Psoriasis and the Revolution in Treatment with Biologic Therapies
Psoriasis is a chronic skin condition affecting 2-3 % of the global population. It is marked by the rapid turnover of skin cells, resulting in thick, scaly plaques commonly found on the elbows, knees, scalp, and lower back. Psoriasis significantly impacts quality of life, causing both physical discomfort and emotional distress.
The Shift from Traditional Treatments to Biologics Historically, psoriasis management relied on phototherapy, methotrexate, and cyclosporine. While effective, these treatments had limitations such as side effects and limited longterm success.
Phototherapy: Involves exposing skin to ultraviolet( UV) light to slow cell turnover. It requires frequent visits and carries risks like skin aging and increased cancer risk.
Methotrexate and Cyclosporine: Systemic immunosuppressive drugs reduce inflammation but can cause severe side effects like liver and kidney damage.
The advent of biologic therapies has revolutionized treatment, especially for moderate to severe cases. Unlike traditional therapies, biologics target specific molecules in the immune system, offering improved efficacy and safety.
Key Biological Pathways in Psoriasis Recent advancements in psoriasis treatment are rooted in a better understanding of the underlying immune mechanisms driving the disease. Two significant discoveries have reshaped the treatment landscape:
The IL-23 / IL-17 Axis: This inflammatory pathway has been identified as a key driver of psoriasis. By blocking this pathway, biologic therapies can prevent the progression of inflammation and skin cell overproduction, leading to better disease control.
Interleukin-17A( IL-17A): IL-17A has been recognized as a central factor in psoriasis pathogenesis. Biologic therapies that specifically target IL-17A have shown some of the most impressive treatment outcomes to date.
Types of Biologics Biologic therapies are typically reserved for patients with moderate to severe psoriasis or psoriatic arthritis, especially those unresponsive to traditional treatments. Key biologics include:
1. TNF-alpha Inhibitors: Adalimumab( Humira), etanercept( Enbrel), and infliximab( Remicade) block TNF-alpha, a cytokine promoting inflammation.
2. IL-12 / 23 Inhibitors: Ustekinumab( Stelara) targets interleukins 12 and 23, which drive the immune response leading to psoriasis.
3. IL-17 Inhibitors: Secukinumab( Cosentyx) and ixekizumab( Taltz) block IL-17, reducing plaque formation. These treatments show rapid and significant skin clearance.
4. IL-23 Inhibitors: Newer biologics like guselkumab( Tremfya) and risankizumab( Skyrizi) specifically target IL-23, offering a highly targeted approach with fewer side effects and excellent clinical results.
Efficacy of Biologic Therapies: PASI Scores The efficacy of biologic therapies is measured using the Psoriasis Area and Severity Index( PASI), which assesses the severity and extent of psoriasis. Improvements in PASI scores gauge treatment effectiveness.
PASI 75: Achieving a 75 % reduction in PASI score is a common goal. TNF-alpha inhibitors like adalimumab and etanercept typically reach this target in 50-70 % of patients within 12-16 weeks.
PASI 90 and PASI 100: More recent biologics, such as IL- 17 and IL-23 inhibitors, set new standards, achieving PASI 90( 90 % improvement) or even PASI 100( complete skin clearance). IL-17 inhibitors like secukinumab and ixekizumab achieve PASI 90 in 70-80 % of patients and PASI 100 in 40-60 %. IL-23 inhibitors show PASI 90 responses in over 80 % and PASI 100 in about 50 %.
Complications and Safety Profile While highly effective, biologic therapies are not without risks. Common side effects include: 1. Increased risk of infections: Due to immune system modulation, patients may be more susceptible to infections, particularly respiratory infections. However, the risk of serious infections, such as tuberculosis, is relatively low with proper screening and monitoring.
2. Injection site reactions: Some patients experience mild reactions such as redness, swelling, or itching at the injection site.
3. Long-term safety: Biologics are generally considered safe for long-term use, though ongoing studies are needed to fully understand their long-term risks, particularly concerning malignancy and autoimmune diseases.
Despite these potential risks, biologics have a more favorable safety profile than traditional systemic therapies like methotrexate and cyclosporine, which can cause significant organ toxicity.
Conclusion: Personalized Treatment with Biologics Biologic therapies have revolutionized psoriasis treatment, providing more targeted, effective, and safer options. For moderate to severe cases, biologics offer significant and lasting skin clearance. Treatment decisions should always be personalized, with close collaboration between patients and dermatologists to weigh the benefits, risks, and costs of therapy. With proper management and the right treatment plan, psoriasis patients can achieve an improved quality of life.
Dr Teh Yih Herng Consultant Dermatologist MD( USM), MRCP( UK), Advanced Master of Dermatology( UKM), Fellowship in Dermatologic Laser Surgery( Thailand)