Panelists Provide Sneak Peek at Potential new Psoriasis Treatments

MAUI, HAWAII — Several different psoriasis treatments, including those that would provide much needed relief for pediatric patients, are currently making their way through the product pipeline, two panelists at Maui Derm for Dermatologists 2020 said.

Craig L. Leonardi, MD, adjunct professor of dermatology at Saint Louis University, offered a sneak peek at some of the new treatments.

According to Leonardi, Otezla (apremilast, Celgene) is a possible treatment for pediatric patients with moderate to severe psoriasis, as studies have shown this oral treatment lowered mean baseline Psoriasis Area and Severity Index score (PASI) by at least 50%. In addition, at least some patients had a positive 2-point difference on Physician's Global Assessment (sPGA) of the severity of the patient’s induration, scaling and erythema. Common adverse events tied to apremilast use were nausea, diarrhea, headache and vomiting.

“Oral psoriasis treatments are interesting to the pediatric population for the obvious reasons,” he said. “Parents don't like doing the injections and going to a doctor’s office to get the injections is pretty burdensome. But with the adverse events, this is going to be very tough to administer to patients. Parents that are going to be all over us and it may hinder stable dosing over time.”

Another potential option for pediatric patients with psoriasis is the injectable Taltz (ixekizumab, Lilly). He noted that in trials, sPGA scores tended to increase in patients who took ixekizumab. When compared head-to-head with Tremfya (guselkumab, Jannsen), ixekizumab was linked to increased PASI scores for the first 16 weeks of treatment.

A third possible treatment, the pill BMS-986165, achieved greater clearing of psoriasis vs. placebo over a period of 12 weeks in the adults studied. A fourth potential treatment, the injectable bimekizumab (UCB), resulted in improvements to Investigator’s Global Assessments and significant improvements in several PASI scores vs. placebo in the adults studied.

“It's all good for psoriasis these days,” Leonardi concluded. “It’s not slowing down.”

Linda Stein-Gold, MD, director of dermatology clinical research at Henry Ford Health System, also offered a preview of potential new topical treatments in psoriasis.

The first possible treatment that she discussed was the oral hydrocarbon reductase agonist tapinarof (Dermavant) for skin barrier repair effects. Thus far, trials have assessed adults with psoriasis comparing a once daily vs. twice daily treatment at doses of 1% vs. 0.5%, she said.

“We found statistically significant improvement in every single one of the active arms,” Stein-Gold said. “However, it looks like a higher concentration when you take the 1% once a day. About 56% to 65% of patients had clear or almost clear skin.”

The second potential treatment that she mentioned, the phosphodiesterase-4 inhibitor roflumilast, “is actually up to 300 times more potent than [some current treatments.].” She noted that 67% of patients saw improvement in their skin at 4 weeks. Phase 2b trials of roflumilast are almost underway, according to Stein-Gold.

“The bottom line is that topicals are still critically important in our treatment of psoriasis,” she said. “And fortunately, we have a very active treatment pipeline.”

Reference: Leonardi CL, Stein-Gold, L. Psoriasis 2020. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.