Leon H. Kircik, MD, FAAD
Associate Clinical Professor of Dermatology
Indiana University School of Medicine, Indianapolis, IN, USA
Icahn School of Medicine, Mount Sinai Medical Center, New York, NY, USA
New and emerging therapeutic agents are based upon the underlying immune mechanisms and aim to alter the natural course of the disease . Interleukin 17 (IL-17A-F) plays a key role in inflammatory disease development; therefore, research into the IL-17 family underlies the development of new therapeutic advances for psoriasis . IL-17F plays an important role in the regulation of inflammatory responses that differ from IL-17  Neutralizing IL-17F in addition to IL-17A is based upon reasoning that includes the fact that both share approximately 50% structural homology, have similar proinflammatory functions, are expressed at inflammation sites, and cooperate with other cytokines to mediate inflammation .
New and emerging therapeutic agents are based upon the underlying immune mechanisms and aim to alter the natural course of the disease .
Risankizumab. In a trial comparing the impact of risankizumab versus ustekinumab at 16 weeks based upon change in PASI (Psoriasis Area Severity Index) score from baseline, risankizumab demonstrated nearly double the efficacy compared to ustekinumab, while both demonstrated clinically significant efficacy compared to placebo .
Bimekizumab. In the BE ACTIVE study bimekizumab PASI 90 response rates demonstrated that IL-17F contributes to chronic tissue inflammation .
Tazarotene/halobetasol. This combination topical lotion demonstrated increased efficacy in phase 3 randomized, double-blinded trials compared to use of tazarotene as monotherapy for the treatment of psoriasis.
Certolizumab pegol. It was studied in women with chronic inflammatory disease to determine the safety of this biologic during breast feeding. There was no/minimal transfer from plasma to breast milk .
Etanercept AutoTouch reusable auto injector. This offers an ergonomic handle; a needle designed to stay hidden during the injection; sensors to detect placement on skin; a speed switch with three injection speeds; a progress bar and a speaker. The new drug formulation that was associated with substantially lower mean injection site pain than the current formulation.
Brodalumab. The psoriasis treatment brodalumab was studied for certain psychiatric adverse effects due to the higher rates of psychiatric comorbidities such as suicidal ideation and behavior among those with psoriasis . Treatment with brodalumab was not associated with an increase in psychiatric events or adverse effects .
Mirikizumab. This psoriasis medication demonstrated a clinically significant improvement in PASI 90 response over 16 weeks. There was a strong dose-response relationship, with higher dose groups achieving better responses. The rate of adverse events was similar to placebo .
New formulation technology optimizes delivery of active ingredients into target tissue.
This technology is also more patient centered and more convenient to use.
The vehicle is an oil-droplet for molecules that do not solubilize easily.
Skin irritation is reduced because there are fewer surfactants.
The structure of the vehicle protects the active ingredients from degradation.
Key Messages/Clinical Perspectives
Ongoing research into novel pathways is producing new and emerging therapies that offer patients improved outcome over prior treatments.
In addition to pharmacologic improvements in active ingredients, technological improvements in the vehicle will optimize delivery with improved convenience and protect the topical treatments from degradation.
Glatt S, Baeten D, Baker T, et al. Dual IL-17A and IL-17F neutralisation by bimekizumab in psoriatic arthritis: evidence from preclinical experiments and a randomised placebo-controlled clinical trial that IL-17F contributes to human chronic tissue inflammation. Ann Rheum Dis. 2018;77(4):523-532.
Clowse ME, Forger F, Hwang C, et al. Minimal to no transfer of certolizumab pegol into breast milk: results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study. Ann Rheum Dis. 2017;76(11):1890-1896.
Reich K, Rich P, Maari C, et al. Efficacy and Safety of Mirikizumab (LY3074828) in the Treatment of Moderate-to-Severe Plaque Psoriasis: Results from a Randomised Phase 2 Study. Br J Dermatol. 2019.
Xue X, Soroosh P, De Leon-Tabaldo A, et al. Pharmacologic modulation of RORgammat translates to efficacy in preclinical and translational models of psoriasis and inflammatory arthritis. Sci Rep. 2016;6:37977.
Presenter disclosure(s): The presenter has reported relationships with the following companies:
We are pleased to present highlights from the 2019 Annual Meeting of the American Academy of Dermatology (AAD). Our meeting was held from March 1 to March 5, 2019 in Washington, DC. The AAD conference … [ Read all ]