The Latest Buzz on Psoriasis

Nearly 7.5 million people in the United States have psoriasis according to the American Academy of Dermatology Association¹, and it’s an issue that continues to be a big problem year after year.

But more drugs and treatment options continue to be explored, and in 2022, there were some exciting advancements in these areas for dermatologists treating psoriasis, starting with four important FDA approvals.

Perhaps most importantly, deucravacitinib (Sotyktu; Bristol Myers Squibb), an oral, allosteric TYK2 inhibitor, became the first oral therapy approval in more than a decade, after Phase 3 POETYK PSO-1 and POETYK PSO-2 clinical trials proved successful.

“Sotyktu has the potential to become the new standard of care oral treatment for people with moderate-to-severe plaque psoriasis, given its profile in helping patients achieve clearer skin as demonstrated in the POETYK PSO clinical program,” said April Armstrong, MD, MPH, associate dean and professor of Dermatology at the University of Southern California.

The FDA also approved tapinarof (VTAMA; Dermavant) cream 1%, a once-daily, steroid-free topical treatment for plaque psoriasis in adults regardless of disease severity, becoming the first FDA-approved steroid-free topical medication.

A third FDA approval came for roflumilast cream (ZORYVE; Arcutis Biotherapeutics) 0.3%, a topical PDE4 inhibitor of plaque psoriasis, including intertriginous areas, in patients 12 years of age and older, which clears plaques and reduces itch rapidly in all affected areas of the body, including intertriginous areas.

The fourth major FDA approval was for Boehringer Ingelheim’s spesolimab (SPEVIG), the first major treatment of generalized pustular psoriasis (GPP) flares in adult patients.

“GPP can have an enormous impact on patient's physical and emotional wellbeing,” said Thomas Seck, MD, senior vice president of medicine and regulatory affairs for Boehringer Ingelheim. “With the FDA approval of this new treatment, people living with GPP now have hope in knowing that there is an option to help treat their flares.”

Suzanne Friedler, MD, FAAD, a dermatologist at Advanced Dermatology PC in New York, noted the new classes of tropical treatments are something that has excited many dermatologists in 2022.

“Tapinarof and roflumilast are obviously the new topical treatments, and there are the new JAK inhibitors that are also very exciting—these are novel mechanisms of action, and what’s great about these new medications is that they also prolong remission,” she said. “You have a once-a-day treatment that patients use, and when patients clear, they stay clear for quite a long period of time, which we call a remittive effect.”

Previously, the only other treatment that had similar remittive effect for psoriasis was tazarotene, which was often irritating to the skin, which is not true for these new tropical treatments.

Research continues of course, and there are many things in the pipeline that dermatologists hope will be game changers in 2023 and beyond.

Friedler noted there are new biologics coming out, new JAK inhibitors and other oral therapies, and she expects Deucravacitinib to become even more prominent in the year ahead.

“The exciting thing about deucravacitinib is that it doesn’t have the black box warnings that are on many new JAKs because it works through one of the receptors, so is more JAK adjacent and doesn’t give you the same concerns,” she said. “It’s a safer treatment, therefore, and better than previous oral treatments.”

She explained that having an oral option is welcomed by dermatologists because a lot of the best treatments had been injectables.

“Tolerability is important; with steroids you have to worry about atrophy to the skin, but with these newer medications, that’s no longer a worry,” Friedler said.

Fred Pescatore, MD, notes there are also some holistic approaches that gained prominence this year. For instance, Pycnogenol, a standardized natural plant extract from French maritime pine tree bark, is a natural supplement that researchers have found improves symptoms of psoriasis.

“It’s been shown to significantly improve the painful and visible symptoms of psoriasis, including redness, flaking, thickness, and total surface area of affected skin patches,” he said. “After just 12 weeks of supplementation with Pycnogenol, the area of skin affected by psoriasis in all body regions was decreased by 20%, compared to just 8% with standard management.”

It’s important for dermatologists to keep up on the latest drugs and treatments and share their findings with patients who may not be as up to date on what’s available to help.

Clients with psoriasis can be challenging to treat, however providing genuine care, education and resources for these people not only helps change their experience with this chronic condition, but creates a sense of trust that builds a loyal practice and clientele.

Reference

1. Psoriasis clinical guideline. American Academy of Dermatology Association. Accessed December 15, 2022. https://www.aad.org/member/clinical-quality/guidelines/psoriasis#:~:text=Psoriasis%20is%20a%20chronic%2C%20inflammatory,risks%20that%20may%20be%20associated.