New Developments in the Treatment of Psoriasis

Lebwohl, Mark

doi:10.1001/archderm.138.5.686

Cited by 46 publications

(26 citation statements)

References 14 publications

(10 reference statements)

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“…In efalizumab studies for which the information is available, slightly more efalizumab- than placebo-treated patients had received systemic PUVA therapy (38.5 vs. 34.7%). Many efalizumab-treated patients also had prior exposure to methotrexate (31.1%) or cyclosporine (9.0%), therapies that have been identified as potential risk factors for LPD [41]. In a murine model study, inhibition of CD11a by efalizumab did not appear to be associated with an increase in lymphoma relative to chronic cyclosporine treatment (Genentech Inc., data on file).…”

Section: Discussionmentioning

confidence: 99%

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Toth¹,

Cather²,

Langley³

et al. 2006

Dermatology

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Background: Psoriasis is a chronic, incurable immune-mediated disease. Most therapies used for moderate to severe psoriasis are immunosuppressive. Agents that depress immune function, including traditional psoriasis therapies, have been associated with an increased incidence of malignancies. Efalizumab is a recombinant monoclonal immunoglobulin G1 (IgG1) antibody approved for use in psoriasis patients. Objectives: To evaluate the incidence of malignancy in patients receiving efalizumab during clinical trials compared with placebo-treated patients, psoriasis patients from external cohorts and the general US population. Methods: Patient data were pooled from multiple phase III placebo-controlled, open-label efalizumab clinical trials, and the incidence rate of reported malignancies was calculated as a function of patient years of observation. The results for the efalizumab-treated patients were compared with the data on psoriasis patients from insurance claims databases and a registry of events in the general population. Results: The efalizumab- and placebo-treated patients had similar incidence rates of malignancy, including lymphoproliferative disease, solid tumor, malignant melanoma and nonmelanoma skin cancer. The incidence of nonmelanoma skin cancers, including basal cell carcinoma and squamous cell carcinoma, in patients receiving efalizumab or placebo was elevated relative to the external databases. Conclusions: These results suggest that efalizumab treatment does not increase a patient’s risk for malignancy. The difference observed with nonmelanoma skin cancer may be due to biases introduced by the clinical trial methodology. Additional patient observation is necessary to ascertain whether a link exists between efalizumab therapy and nonmelanoma skin cancer above that normally observed in psoriasis patients.

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Section: Discussionmentioning

confidence: 99%

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Toth¹,

Cather²,

Langley³

et al. 2006

Dermatology

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“…6 Additional disadvantages include the direct and indirect expenses incurred during treatment, the short-term risk of sunburn, and, for PUVA in particular, long-term risk of cutaneous malignancy. 2,24,25 Nonbiologic Systemic Therapies Traditional systemic therapies for psoriasis, such as methotrexate, cyclosporine, and oral retinoids (e.g., acitretin), although effective, are associated with serious toxicities. 3,26 Cyclosporine has demonstrated efficacy in the treatment of psoriasis in numerous clinical trials; however, the wide variation in design among those trials contributes to substantial variability in response rates.…”

Section: Topical Therapiesmentioning

confidence: 99%

Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy

Finlay

Ortonne

2004

J Cutan Med Surg

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“…The presence of these antibodies is not only associated with a reduction in response to infliximab, but is also associated with the development of infusion reactions. 64,65 The combination of infliximab with low-dose methotrexate can decrease human antichimeric antibody formation and result in increased overall efficacy, decreased chance of loss of treatment efficacy, and decreased rates of infusion reactions. 66 …”

Section: Infliximabmentioning

confidence: 99%

Biologics in the treatment of psoriasis and emerging new therapies in the pipeline

Levy¹,

Solomon²,

Emer³

2012

PTT

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Elucidation of the immunopathogenesis of psoriasis has led to the discovery of novel biologic agents for the treatment of moderate-to-severe plaque psoriasis. There are currently five biologic agents approved by the US Food and Drug Administration for psoriasis which have proven to be quite efficacious in clinical trials and in post-marketing and clinical experience. As more details are uncovered about the immunologic pathways involved in initiation and maintenance of this disease, there will be an increasing development and marketing of novel therapeutics. It is crucial to understand the immunopathogenesis of psoriasis and the mechanisms of these novel agents in order to to treat the psoriatic population effectively and mitigate disease burden. This article reviews the currently approved biologics for the treatment of psoriasis, with emphasis on efficacy and safety. There are countless therapies currently in the research pipeline, with mechanisms ranging from receptor antagonism to signal transduction pathway inhibition. The initial trials and future studies involving these new agents are also reviewed. As therapeutics escalate through the research pipeline, the management and treatment of psoriasis will likely become more manageable for practitioners and patients.

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New Developments in the Treatment of Psoriasis

Cited by 46 publications

References 14 publications

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy

Biologics in the treatment of psoriasis and emerging new therapies in the pipeline

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