What You Need To Know About Psoriasis
When you think of a disease that can cause pain, fatigue and depression and raise your risk of heart disease, diabetes and premature death, psoriasis probably doesn’t come to mind, but it should.
Psoriasis affects more than one million Canadians, regardless of age, gender or ethnicity. It’s a chronic inflammatory skin condition that features elevated red patches and flaking silvery scales. But patients know all too well that it isn’t just a skin disease; it’s a condition that affects many aspects of their lives, from their health and daily functioning to their life decisions and even relationships.
A few years ago, the World Health Organization (WHO) drafted a resolution calling for action to recognize the toll that the condition takes on people’s lives, improve access to treatment and reduce its stigma. The WHO also underlined that psoriasis carries the risk of developing other serious, chronic conditions, such as cardiovascular disease, diabetes, obesity, ulcerative colitis, stroke and liver disease. While science is only starting to explore links to other diseases, some researchers think that controlling psoriasis by reducing inflammation may also reduce the risk of developing other health issues.
Looking For Relief
I recently co-authored the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) study, the largest international survey ever conducted, which included 3,400 people with psoriasis or psoriatic arthritis. It highlights what we still need to know to better understand how psoriasis sufferers feel about their disease and treatment and how we can help them. Our study found that most patients aren’t adequately managed. Many are on topical therapies (usually geared to mild disease) or receive no treatment. Some patients become so disenchanted with treatments that are too inconvenient, uncomfortable, ineffective or expensive that they forgo treatment. Eighty-five percent of patients report a need for new therapies.
Treatment Options For Psoriasis Symptoms
Various drugs are available to manage psoriasis symptoms, but not every therapy works equally well for every patient. Our MAPP findings showed that more than half (57 percent) of patients taking traditional oral medications and just under half (45 percent) of those on newer biologic drugs discontinued them due to issues of safety, tolerability and lack or loss of efficacy.
For patients with moderate to severe disease, which affects large areas of skin or even smaller areas that are crucial to daily living (such as hands, feet or genitalia), therapy may include oral drugs and biologic agents (given by injection or infusion). The latter drugs work by targeting certain chemical messengers in the immune system, such as interleukin-17, which promotes inflammation. One drug that’s being called the next breakthrough drug is called secukinumab, which blocks this inflammation chemical messenger. Research continues the quest for even better treatments that boast higher efficacy rates and fewer adverse effects.
The Success of Injections and Infusions
My colleagues and I at Dalhousie University recently published findings that 80 percent of patients treated with this new biologic agent experienced a rapid, significant clearing of symptoms that was sustained over time. Other drugs that target the same proteins are being studied, including ixekizumab and brodalumab.
An oral drug called apremilast that has a very good safety profile is also under investigation for psoriasis and psoriatic arthritis. It was recently approved for use for both conditions in the United States. So far, psoriasis isn’t curable or preventable, but we do have some tools to manage it. There’s still a lot of room for improvement, and we’re working on it.
Dr Richard Langley is past president of the Canadian Dermatology Association and a professor and director of research in the Division of Dermatology, Department of Medicine, at Dalhousie University.