Plaque Psoriasis - News About Treatments

Overview

Every year, researchers learn more about the pathophysiology of psoriasis and the role of the immune system in this condition. By using this knowledge, they can develop new treatments that are more targeted and effective compared to the available ones.

Additionally, new drugs can offer an opportunity to patients who failed to respond to conventional therapies – we call these resistant cases.

Like other autoimmune diseases, the future treatments of psoriasis revolve around biological drugs. Using these medications can regulate the response of the immune system, which should improve the symptoms of plaque psoriasis.

Some common targets of biological drugs include:

• Tumor necrosis factor-alpha (TNF-alpha) – a protein responsible for promoting inflammation in the body
• T cells – a type of white blood cells that play a fundamental role in psoriasis
• Interleukins – small inflammatory proteins that promote autoimmunity when regulation is absent

In this article, we will cover some of the new treatments that target plaque psoriasis to help you manage your expectations.

Plaque Psoriasis – New Treatments 

1. Risankizumab-rzaa (Skyrizi)

Risankizumab-rzaa (Skyrizi) received approval from the United States Food and Drug Administration (FDA) back in 2019. This treatment mainly focuses on severe cases of plaque psoriasis that could benefit from phototherapy.

The target protein of Skyrizi is interleukin-23 (IL-23).

If your doctor prescribes this treatment, you will receive two doses on each occasion. The treatment is given subcutaneously (i.e., under the skin).

Potential side effects include:

• Upper respiratory infections
• Pain at the injection site
• Headache
• Tiredness
• Fungal infections

Certolizumab pegol (Cimzia)

While this drug received FDA approval to treat Crohn’s disease and psoriatic arthritis a while back, the use of Cimzia to treat plaque psoriasis was only approved recently.

The purpose of this drug is to treat moderate to severe cases of plaque psoriasis. The targeted protein is TNF-alpha.

The drug is generally administered subcutaneously every other week.

The most common side effects of Cimzia are:

• Upper respiratory tract infections
• Rash
• Urinary tract infections (UTIs)

Guselkumab (Tremfya)

Guselkumab (Tremfya) is another drug that received FDA approval to treat severe plaque psoriasis. Tremfya targets IL-23 to inhibit the inflammatory response that causes accelerated skin turnover.

Tremfya is also administered subcutaneously.

Common side effects include:

• Headache
• Upper respiratory infections
• Reactions at the injection site
• Joint pain
• Diarrhea
• Stomach flu

Brodalumab (Siliq)

Brodalumab (Siliq) is a monoclonal antibody that targets the receptor of IL-17. Blocking the action of IL-17 showed impressive clinical improvement of moderate to severe cases of plaque psoriasis.

To receive this treatment, you need to meet certain criteria:

• Having moderate to severe plaque psoriasis
• Being a candidate for phototherapy
• Failing to respond to other conventional systemic treatments

The clinical trials of this medication revealed that patients who receive it are more likely to have clearer skin than those who receive a placebo.

The administration of Siliq is done via a subcutaneous injection. It also has similar side effects to other biological drugs.

We should note that patients with a medical history of depression and suicidal thoughts may not be apt to receive this medication due to the reported side effects of increasing suicidal ideation.

Plaque Psoriasis – Topical Treatments

Topical treatments refer to a category of medications that you apply directly to your skin. In the case of psoriasis, topical treatments are often the first-line therapy as they often cause limited side effects relative to oral and injectable drugs.

 

 

Here are the newest topical medications that received FDA approval to treat plaque psoriasis:

Halobetasol propionate-tazarotene lotion (Duobrii)

In April 2019, the FDA approved halobetasol propionate-tazarotene lotion for the treatment of plaque psoriasis in adults.

Duobrii results from combining a corticosteroid (i.e., Halobetasol propionate) with a retinoid (i.e., tazarotene). 

The action of the corticosteroid regulates the immune response and clears out the plaques, whereas the retinoid halts the overgrowth of skin cells.

You can start applying Duobrii once a day on the areas affected by plaque psoriasis.

The main side effects are:

• Pain at the application site
• Rash
• Folliculitis (i.e., inflamed hair follicles)
• Excoriation

Halobetasol propionate foam (Lexette)

Halobetasol propionate is a topical corticosteroid available under the brand name Lexette to treat plaque psoriasis in adults.

You apply the foam twice a day and rub it into your skin.

The most prevalent side effects of this drug include:

• Pain at the application side
• Headache

Halobetasol propionate lotion (Bryhali)

Halobetasol propionate lotion (Bryhali) is also intended for adults with mild cases of plaque psoriasis.

This drug addressing the following symptoms:

• Dryness
• Flaking
• Inflammation
• Plaque buildup

You can apply Bryhali on a daily basis for up to 8 weeks.

The most common side effects are:

• Burning
• Stinging
• Itching
• Dryness
• Upper respiratory tract infections
• High blood sugar

Betamethasone dipropionate spray (Sernivo)

This steroid drug received FDA approval to treat mild to moderate plaque psoriasis in patients above the age of 18.

Clinical studies showed that Sernivo improves itching, flaking, and redness.

The way you apply this drug is by spraying it on the affected skin twice a day. After that, you rub it gently until the product is invisible. Note that patients could receive this treatment for up to 28 days.

The most common side effects are:

• Itching
• Burning
• Stinging
• Skin atrophy
• Pain at the application site

Takeaway message

To develop new treatments of plaque psoriasis, researchers need to invest millions of dollars in lab work and clinical trials. Fortunately, these enormous efforts are starting to pay off by offering patients more options to improve their symptoms. 

In the past, when someone had a resistant case of psoriasis – symptoms that do not improve after trying all conventional therapies, doctors would opt for risky and unsafe methods. The positive side is that the new drugs give your dermatologist a wide range of options to address your symptoms.

We hope that this article managed to shed some light on the new treatments of plaque psoriasis and their potential role in improving the outcome of patients.

If you want to read more about psoriasis, you can read this article.

Written by Zac Hyde M.D.