wbur Narrating Medicine A new category of drugs, biologics, inhibits elements of the immune system that fuel inflammation. Humira is an example of a biologic. (David J. Phillip/AP)
My body is a walking encyclopedia covering 40 years of psoriasis treatments.
I've had hundreds of cortisone injections shot into my scalp, arms and legs. Thick black tar applied to my head so it could be absorbed into the scaly red plaques that surfaced when my condition flared. Salicylic acid shampoos that stunk like hot asphalt. Light box treatments. Methotrexate and cyclosporine, immune system suppressants prescribed variously for cancers, rheumatoid arthritis and organ transplant recipients.
And still, it was there. Always, or nearly always. The inflamed, flaking, cracking skin. Wavy ridges in my fingernails. Hundreds of hours spent in dermatology offices. Thousands of attempts to hide painful, embarrassing skin patches that would appear on elbows, knees, scalp and other surprising places when I was under stress, on a deadline, or for no obvious reason at all.
I am not alone. Last year, the World Health Organizations Global Report on Psoriasis called the disease a "serious global problem with at least 100 million individuals affected worldwide." That includes more than 7 million Americans. We are legion. With lesions.
Psoriasis is a mystery, a disease of the immune system with no clear cause or cure. For years, traditional medications that were developed initially for arthritis, Crohn's disease or other immune conditions eventually dropped down the pharmaceutical food chain to psoriasis patients.
Lately, though, that landscape has been shifting, with the advent of a new category of drugs: biologics, genetically engineered proteins derived from human genes. Usually injections that a patient administers at home, they inhibit elements of the immune system that fuel inflammation.
Humira, Enbrel and Cosentyx are examples of biologics. And a recent paper in The Lancet shows promise for a new biologic called tildrakizumab. Designed primarily for psoriasis, it may ultimately have additional applications.
Tildrakizumab differs from earlier, similar biologics by targeting a very specific immune system pathway.
"The breakthrough is that we have continued to refine our treatments to those that are likely to be most effective against psoriasis but less likely to affect other important pathways at the same time," says study senior author Dr. Alexa Kimball, a dermatologist and presidentof Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston.
From Accidental Findings To'First In Line'
Psoriasis treatments have mostly been accidental discoveries, Kimball said.
Occasionally, a psoriasis patient who needed an organ transplant would end up being treated with cyclosporine, and it was amazing how a drug like that cleared the skin, sheexplained. And so there was this sort of accidental-incidental way that early psoriasis treatments were discovered.
Treatment evolved with those incidental discoveries, including traditional medications such as cortisone and cyclosporine, which are still prescribed frequently for mild to moderate psoriasis.
The first generation of biologics to treat psoriasis entered the market in the early 2000s. They have fewer side effects than traditional medications (the cyclosporine Im currently taking can impact liver and kidney function), are generally well tolerated, and the majority of patients don't mind injecting themselves.
But they still carry the risks of immune suppression, including reactivation of tuberculosis, and increased susceptibility to viral infections and certain cancers.
Immune proteins evolved to protect us from infection, explained immunologist Dr. Sarah Gaffen of the University of Pittsburgh. So when you start blocking them, youre going to raise the specter of some sort of infectious disease.
The good news is that highly focused drugs, like tildrakizumab, do mean greater improvement on psoriasis symptoms with far fewer side effects. Gaffen refers to the targeted nature of biologics as exquisitely specific.
And because psoriasis isnt a life or death matter, patients who are enrolled in research protocols can also be put on placebos with limited risk to their overall health. Thats not an option with arthritis or Crohns disease, where irreversible harm might be done without ongoing treatment. And, as Kimball added, The results are right in front of your face with psoriasis. You can see such a dramatic improvement.
More good news: In drug development these days, psoriasis has been gaining traction as a proof of principle disease, according to Kimball. If a medication did well on psoriasis, it was pretty likely to do well in other [immune] areas.
"The paradigm has completely switched," she added. "Psoriasis was last in line 10 or 15 years ago. Now its often first.
High Hopes, High Prices
Now for the not-so-good news, long familiar to anyone who takes biologics: the price tags.
While tildrakizumab isnt yet on the market, other biologics are, and I was recently introduced to the challenge of acquiring them.
I was having a severe psoriasis flare. Red, cracked, inflamed skin, so painful it was difficult to bend my arms or sit. My dermatologist prescribed Humira.
The prescription was filled before my insurance company had a chance to determine coverage. I asked the pharmacist how much the medication would cost if I paid out of pocket.
She looked at the computer screen, and then at me. Then again at the computer. I raised my eyebrows.
Do you want to guess? she asked me.
$600, I ventured.
She shook her head.
$6,000?
She shook her head again. I shrugged. She paused. $30,000.
$30,000? I repeated. I might as well buy a car.
You should, she said. Because thats not even for the whole year.
Kimball confirmed the cost. Usually we expect these drugs at list prices to run around $50,000 a year. They are very expensive drugs, she said.
Needless to say, I postponed the Humira. I may start on it this fall, when it's fully covered.
In 2016, Humira grossed over $16 billion, putting it in first place for the best-selling drug of the year, according to Genetic Engineering & Biotechnology News, a trade publication.
According to the WHO report, treatments for psoriasis around the world --whether simple creams or complex biologics --are either unavailable or are not reimbursed for the majority of patients. And its hard to imagine anyone paying $50,000 to Walgreens out of a checking account.
Yet biologics offer the greatest advances yet in treating immune-regulated diseases. And tildrakizumab, while developed for moderate to severe psoriasis, may be one that also holds the potential to benefit other diseases in the future.
I hope those of us who need it will have access. Kimball recognizes this hurdle: "Figuring out how to get this right," she said, "so we ensure access to the patients who need these medications, is one of the things that absolutely keeps me up at night."
Beth Jones is a Boston-based writer and educator.
The rest is here:
Progress On Psoriasis, From 'Last In Line' To Often First, But At A Price - WBUR
- Why Jews With Psoriasis Might Think Twice About Seeking Treatment in Jordan - December 20th, 2013 [December 20th, 2013]
- Skin conditions leave emotional scars - December 20th, 2013 [December 20th, 2013]
- Psoriasis Free Forever Review | How This Program Helps People Treat The Root Causes Of Their Psoriasis Symptoms ... - December 20th, 2013 [December 20th, 2013]
- Psoriasis | University of Maryland Medical Center - December 20th, 2013 [December 20th, 2013]
- Psoriasis Treatment, Symptoms, Pictures, Types, Prognosis ... - December 20th, 2013 [December 20th, 2013]
- Psoriasis - National Library of Medicine - PubMed Health - December 20th, 2013 [December 20th, 2013]
- Psoriasis: MedlinePlus - U.S. National Library of Medicine - December 20th, 2013 [December 20th, 2013]
- Psoriasis - Wikipedia, the free encyclopedia - December 20th, 2013 [December 20th, 2013]
- Psoriasis Symptoms, Treatment, Causes, Medication Information ... - December 21st, 2013 [December 21st, 2013]
- Psoriasis Free For Life Review - Watch This Before You Buy - Video - December 21st, 2013 [December 21st, 2013]
- Natural Psoriasis Relief in Seattle, Washington - Video - December 21st, 2013 [December 21st, 2013]
- PSORIASIS VULGARIS - Video - December 21st, 2013 [December 21st, 2013]
- Top 5 Powerful Home Remedies For Psoriasis - Video - December 21st, 2013 [December 21st, 2013]
- Psoriasis feedback after hijama - Video - December 21st, 2013 [December 21st, 2013]
- 9 Home Remedies For Scalp Psoriasis - Video - December 22nd, 2013 [December 22nd, 2013]
- Manga - Psoriasis - Video - December 22nd, 2013 [December 22nd, 2013]
- How to treat psoriasis | In Good Shape - Interview - Video - December 22nd, 2013 [December 22nd, 2013]
- Best Scalp Psoriasis Treatment - Video - December 22nd, 2013 [December 22nd, 2013]
- Sandoz begins Phase III clinical trial for biosimilar adalimumab - December 23rd, 2013 [December 23rd, 2013]
- Psoriasis - Wikipedia, la enciclopedia libre - December 23rd, 2013 [December 23rd, 2013]
- What Is Psoriasis? - December 23rd, 2013 [December 23rd, 2013]
- Psoriasis Treatment Medical Course - Video - December 23rd, 2013 [December 23rd, 2013]
- Healing Psoriasis Hypnosis Session - Video - December 23rd, 2013 [December 23rd, 2013]
- Natural Farm cure for Skin Problems like Psoriasis - Video - December 26th, 2013 [December 26th, 2013]
- Psoriasis - 100% Natural Treatment Shivax® - December 27th, 2013 [December 27th, 2013]
- Psoriasis Symptoms, Causes, Treatment - What is psoriasis ... - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P3 - Video - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P2 - Video - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P1 - Video - December 28th, 2013 [December 28th, 2013]
- Can Acupuncture treat psoriasis and other scalp disorders? - Video - December 28th, 2013 [December 28th, 2013]
- Psoriasis - Wikipédia - December 31st, 2013 [December 31st, 2013]
- Psoriatic nails - Wikipedia, the free encyclopedia - December 31st, 2013 [December 31st, 2013]
- How to Cure Psoriasis - Psoriasis Symptoms, Treatment, Causes, Medication Information - Video - December 31st, 2013 [December 31st, 2013]
- Psoriasis Chronicles - Dealing with Depression, Anxiety and Anger - Video - January 2nd, 2014 [January 2nd, 2014]
- How to Prevent Psoriasis Flare-Ups - January 4th, 2014 [January 4th, 2014]
- Psoriasis Treatment | Health Plus | Studio N - Video - January 4th, 2014 [January 4th, 2014]
- Ayurvedic Remedy for Psoriasis - By Panditha Elchuri - Video - January 4th, 2014 [January 4th, 2014]
- Silica Gel For Psoriasis / Neurodermatitis - Video - January 4th, 2014 [January 4th, 2014]
- comment traiter son psoriasis détail oubliés - Video - January 4th, 2014 [January 4th, 2014]
- Psoriasis tends to relapse after stopping Methotrexate, shown in a case at Life Force - Video - January 4th, 2014 [January 4th, 2014]
- hiking nevada Health and Wellness Enthusiast Dawn Talks About Managing Plaque Psoriasis hiking watch - Video - January 5th, 2014 [January 5th, 2014]
- Guttate psoriasis - Wikipedia, the free encyclopedia - January 7th, 2014 [January 7th, 2014]
- Biofeedback May Help Control Stress-Related Diseases - January 8th, 2014 [January 8th, 2014]
- Psoriasis can be managed with proper treatment - January 10th, 2014 [January 10th, 2014]
- CNN anchor: How I fight psoriasis - January 10th, 2014 [January 10th, 2014]
- Psoriasis - My Home Remedies - January 10th, 2014 [January 10th, 2014]
- Psoriasis: MedlinePlus en español - January 10th, 2014 [January 10th, 2014]
- Psoriatic arthritis - Wikipedia, the free encyclopedia - January 10th, 2014 [January 10th, 2014]
- CNN anchor Zain Verjee: How I fight psoriasis - January 11th, 2014 [January 11th, 2014]
- Testimonio psoriasis - Video - January 14th, 2014 [January 14th, 2014]
- Heroin addict with severe Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- biospray for Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- Psoriasis - Psoriasis Free For Life - Video - January 15th, 2014 [January 15th, 2014]
- 8 Cure For Scalp Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- Learn about plaque psoriasis, guttate psoriasis, inverse ... - January 16th, 2014 [January 16th, 2014]
- Psoriasis - Symptoms, Triggers, and Causes of Psoriasis on WebMD - January 16th, 2014 [January 16th, 2014]
- Psoriasis Causes, Symptoms, Treatments, Home Remedies - January 16th, 2014 [January 16th, 2014]
- Psoriasis Treatment - Dermasis Psoriasis Cream - My Honest Review - Video - January 16th, 2014 [January 16th, 2014]
- TV Commercial Psoriasis Speaks Couple Looking At Rings In Jewelery Store Emotional - Video - January 16th, 2014 [January 16th, 2014]
- TV Commercial Humira Psoriasis Medication Salon Clearer Skin is Possible - Video - January 16th, 2014 [January 16th, 2014]
- Psoriasis Symptoms, Causes and Treatment Pictures Slideshow - Video - January 16th, 2014 [January 16th, 2014]
- Psoriasis - Medscape Reference - January 19th, 2014 [January 19th, 2014]
- 5 Home Remedies For Scalp Psoriasis - Video - January 19th, 2014 [January 19th, 2014]
- Ikonsulta Mo: Medical Advise on Psoriasis - Video - January 19th, 2014 [January 19th, 2014]
- Patient Recruitment: Television Campaign for Severe Psoriasis - Video - January 23rd, 2014 [January 23rd, 2014]
- Patient Recruitment: Television Campaign for resistant, summertime Mild to Moderate Psoriasis - Video - January 23rd, 2014 [January 23rd, 2014]
- Dr stephen ferguson ND PhD chronic fatigue psoriasis cured - Video - January 23rd, 2014 [January 23rd, 2014]
- Noir Naturals Age of Innocence (Unscented) Goat's Milk Lotion for Psoriasis Relief - Video - January 23rd, 2014 [January 23rd, 2014]
- New biologic drugs offer relief for psoriasis sufferers - January 24th, 2014 [January 24th, 2014]
- Psoriasis traitement appliquer le lait pour le corps ISO UREA MD Vidéo La Roche Posay INFO PSO - Video - January 24th, 2014 [January 24th, 2014]
- Psoriasis - Video - January 24th, 2014 [January 24th, 2014]
- Coping with psoriasis - Video - January 26th, 2014 [January 26th, 2014]
- Exfoliative Dermatitis/Psoriasis Vulgaris with Psoriatic Arthritis with English Subtitles - Video - January 26th, 2014 [January 26th, 2014]
- Psoriasis skin care routine 2014 - Video - January 27th, 2014 [January 27th, 2014]
- How to treat psoriasis effectively - By Franziska Ringpfeil, Board Certified Dermatologist - Video - January 28th, 2014 [January 28th, 2014]
- My Psoriasis 411: Apple Cider Vinegar Tutorial for Scalp Treatment - Video - January 29th, 2014 [January 29th, 2014]
- 12 Best and Worst Foods for Psoriasis - January 31st, 2014 [January 31st, 2014]
- Psocial Psoriasis en radio Tagoror - Video - January 31st, 2014 [January 31st, 2014]
- Psocial Psoriasis en Canarias Hoy - Video - January 31st, 2014 [January 31st, 2014]
- Psoriasis Natural Treatment that Workswww savevid com - Video - January 31st, 2014 [January 31st, 2014]