Did you know that Psoriasis affects at least 130 Million people around the world? It is a common autoimmune condition that affects not only the skin but a person’s quality of life too. Fortunately, there has been a treatment revolution for those with psoriasis in the last few decades. Because the theme for World Psoriasis Day, 2020 is “INFORMED”, we though we should explore these revolutionary treatments (called biologic treatments) in our blog today.
Psoriasis causes scaly, dry, red (or pigmented) spots on the skin. It can also affect the hair, nails and joints. You can read more about the causes, associations and basic treatment options as well as what psoriasis looks like in skin of colour right here.
As dermatologists in Melbourne, we see a lot of patients living with psoriasis. Many of them have tried numerous lotions and potions before they see us. We offer phototherapy treatment on site for our patients and are also able to provide tablet treatments for those that need it. Sometimes, despite everyone’s best efforts, psoriasis spots won’t budge. In this case, and if a person’s psoriasis is classified severe enough, injection therapy (called biologic therapy) for psoriasis can be considered.
Biologic therapies target a specific part of the body’s immune system to treat and prevent immune-mediated inflammatory disorders. They have revolutionised the way doctors treat things like rheumatoid arthritis, inflammatory bowel disease and psoriasis. They are usually given in the form of injections or infusions through a drip (for Infliximab). The timing of injections varies between biologic agents and the time it takes to get a response will be different for different biologics.
To qualify for biologic therapy through Medicare, patients’ needs to have their psoriasis assessed by a dermatologist to determine the severity of the psoriasis. A “PASI” score is a tool used to measure the severity of psoriasis. Intensity of redness, thickness of the spots, the degree of scale seen, and the body surface area are all evaluated. The scores are plugged into a special mathematical algorithm that spits out a magical number. If the score is above 15 despite treatments (two treatments (phototherapy treatment and tablets) and the patient meets other criterion, a biologic can be considered.
Biologic agents that are currently available in Australia for psoriasis through Medicare include:
• Infliximab (Remicade®) – this belongs to a class of biologics called Tumour Necrosis Factor Inhibitors. It is made from human and mouse antibody molecules.
• Etanercept (Enbrel®) – this also belongs to a class of biologics called Tumour Necrosis Factor Inhibitors. It is made from human protein.
• Adalimumab (Humira®) – this belongs to a class of biologics called Tumour Necrosis Factor Inhibitors. It is an antibody made from human peptides.
• Ustekinumab (Stelara®) – This belongs to the class of biologics called monoclonal antibodies. This is an IL-12/23 blocker.
• Secukinumab (Cosentyx®) – This belongs to the class of biologics called monoclonal antibodies. This blocks a messenger protein called IL-17A
• Ixekizumab (Taltz®) – This belongs to the class of biologics called monoclonal antibodies. This neutralises IL-17A
• Guselkumab (Tremfya®) – This belongs to the class of biologics called monoclonal antibodies. It selectively blocks IL-23
• Tildrakizumab (Ilumya®) – This belongs to the class of biologics called monoclonal antibodies. It blocks IL-23 and inhibits its interaction with the IL-23 receptor
• Risankizumab (Skyrizi®) – This belongs to the class of biologics called monoclonal antibodies. It blocks IL-23.
There are other biologic therapies for psoriasis that will soon be available and others that are being tested in clinical trials right now. The exact biologic chosen will be based on many factors including patient preference and other medical conditions a person may have. We believe that treating psoriasis is more than skin deep. Lifestyle changes, diet, exercise and quality of life all need to be addressed. Please talk to your dermatologist to be INFORMED on this, World Psoriasis Day, 2020.
The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.