Biologic treatments used for psoriasis

Last Modified: Friday, January 4, 2013 at 3:13 p.m.

Psoriasis is a chronic inflammatory skin disease. About 80 percent of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scales. These patches, or plaques, frequently form on the elbows, knees, lower back and scalp. However, the plaques can

occur anywhere on the body.

Between 10 and 30 percent of people who develop psoriasis get a related form of arthritis called "psoriatic arthritis," which causes inflammation of the joints.

Psoriasis occurs about equally in men and women. It is most common in Caucasians and is far less common among Asians and is rare in Native Americans.

One-third of people who develop psoriasis have at least one family member with the condition.

Psoriasis is an immunemediated disease and involves a complex interaction between the genes, the immune system and the environment. Infection, trauma or even stress can trigger a flare-up. For some unclear reasons, T-cells, crucial immune cells, are activated and release chemical mediators such as tumor necrosis factor and interleukin 23, which cause inflammation and accelerate the growth of skin cells. Normally, new cells take about a month to migrate from the lowest skin layer where they’re produced, to

the outermost layer where they die and flake off. With active psoriasis, the entire life cycle is

shortened to just a few days. As a result, cells build up rapidly, forming thick silvery scales and

red patches.

People with psoriasis often experience flare-ups and remissions throughout their life. An estimated 20 percent of patients suffer moderate to severe psoriasis. The goal of treatment is to find the most

effective way to slow cell turnover with the fewest possible side effects. The traditional approach for mild psoriasis is to start with topical creams such as corticosteroid, vitamin D analogus, Anthraline

or coal tar, ultraviolet light therapy (phototherapy) and oral medication such as retinoid.

Immunomodulators such as methotrexate, imuran and cyclosporin also have been used for moderate to severe psoriasis. However, some patients with severe psoriasis still do not respond to this treatment.

In the past decade, thanks to scientific breakthroughs in molecular biology and genetic engineering, we can now produce biologic agents to inhibit T-cell activation or block TNF or interleukin 23. These biologic agents can interrupt inflammatory cascade and decrease skin cell turnover. Several biologic drugs have significantly improved plaque psoriasis and even induced remission, including those containing T-cell activation inhibitors such as Amevive; drugs with anti-TNF agents such as Enbrel, Humira, Simponi and Remicade; and medications with anti-interleukin 12 and 23 such as Stelara.

These biologic agents offer new hope for patients suffering from moderate to severe psoriasis that doesn’t respond well to traditional treatments.



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