New Breakthroughs in Psoriasis Medication: 2024 Update

February 7, 2024

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Affecting over 8 million Americans, psoriasis is a chronic inflammatory condition causing thick, scaly skin plaques that itch, burn and crack. Currently incurable, psoriasis follows an unpredictable course – while topical creams minimize outbreaks for some, others battle agonizing flare-ups refractory to all conventional treatments. Seeking solutions for more effective, convenient and safer methods of care is thus vital.

The last decade has seen incredible advances in psoriasis therapy. Oral pills, biologic injections and novel modalities like laser now expand possibilities beyond ointments and traditional systemic drugs. As research reveals more about psoriasis immunopathogenesis, treatments can target specific mediators for enhanced precision. Let’s explore the latest additions revolutionizing medical management of this life-altering disease.

Oral Psoriasis Medications – Convenience and Efficacy

The first oral treatment for psoriasisOtezla (apremilast), received FDA approval in 2014. Unlike broad immunosuppressants, it selectively inhibits an inflammation-producing enzyme called PDE4. Nearly 33% of patients achieve 75% skin clearance at 16 weeks. It also improves arthritic joint symptoms.

Recently approved in 2022, Sotyktu (deucravacitinib) represents the next big leap as an oral option. The first in its medication class, Sotyktu is a TYK2 protein inhibitor with a novel mechanism reducing psoriasis inflammation. Over 60% of patients reach 75% skin clearance at 16 weeks – results comparable to injectable biologics.

Oral therapies enhance compliance and quality of life against phototherapy/injections. Patients need labs or pre-screening for oral treatment either. However, they don’t work for everyone, with some side effects like gastrointestinal discomfort, headaches and respiratory infections. Still, oral pills expand access and autonomy in psoriasis care.

Latest Biologic and Biosimilar Agents

Biologics like Humira and Enbrel inaugurated the biologic era in dermatology in the 2000s with dramatic skin clearing. However, their generalized immune suppression risked side effects.

The new generation targets specific pathways relevant to psoriasis pathogenesis:

  • IL-23 inhibitors (Skyrizi, Tremfya) block a key inflammatory cytokine
  • IL-17 inhibitors (Siliq, Cosentyx) prevent inflammatory T-cell activation
  • PDE4 inhibitors (Otezla) limit excessive immune responses

Biosimilars like Inflectra, Renflexis and Amjevita also widen access to costlier biologics at reduced prices.

Over 75% achieve 75% clearance with these advanced biologics, with sustained remissions for some. However, they don’t help arthritis. While generally well-tolerated, they may very rarely increase infections or trigger inflammatory bowel disease. Overall though, biologics transform psoriasis prognosis.

Leveraging the Best from Both Worlds

Employing both biologic injections and oral systemic together maximizes outcomes. Each modality tackles inflammation through different but complementary pathways for enhanced control. Lower doses also minimize adverse effects. This facilitates medication adjustments if necessitated by fluctuating symptoms or intolerance over a lifetime.

Concurrent use however warrants close monitoring for cumulative immunosuppression. Doctors usually avoid combining two biologics, or two oral drugs like Otezla and Sotyktu awaiting more safety data. Strategic treatment choicesbalancing efficacy, safety, costs and logistical considerations optimizes benefit.

Biologic therapy with methotrexate provides another well-tolerated combination option enhancing skin clearance. While research on sequencing continues, current consensus suggests switching between mechanism classes if one stops working. Overall, a multi-pronged approach promotes disease remission.

Emergence of Novel Therapeutics

Despite the explosion of approved systemic medications for psoriasis, additional agents focusing on still newer mechanisms continue in the pipeline:

  • JAK inhibitors – oral pills blocking specific inflammation pathways
  • Integrin inhibitors – prevent skin cell activation and recruitment
  • Modified cytokines – regulate immune function

New topical medications like tapinarof cream, roflumilast foam and OPA-15406 lotion also conclude late phase clinical trials with promising results. Device-based interventions like laser, UVB phototherapy, dermabrasion and cryotherapy further expand non-pharmacological options.

Ongoing research also examines whether combining treatments from onset treates psoriasis most effectively before cumulative damage sets in. Such strategic early interventions preserving normal skin function long-term may hopefully prevent treatment resistance and joint deterioration over time.

Frequently Asked Questions

What antibiotics actually help with psoriasis?

While antibiotics don’t treat psoriasis itself, they can target secondary skin infections aggravating symptoms and resulting from skin barrier disruption. Topical gentamicin reduces lesions while oral penicillins prevent recurring streptococcal pharyngitis flares. azithromycin notably also has anti-inflammatory effects benefiting psoriasis directly beyond antibacterial action.

How much prednisone should I take for my psoriasis?

Around 0.5-0.75 mg prednisone per kg body weight for 2-4 weeks is often trialed, especially for unstable, erythrodermic or generalized pustular psoriasis. Higher doses have more side effects with questionable added benefit. Sudden discontinuation also risks disease rebound so gradual tapering is advised. Consider periodic oral prednisone for acute flares only, not continuous long-term therapy.

What are the newest biologic medications for psoriasis?

The IL-23 inhibitor Skyrizi (risankizumab), IL-17 inhibitor Siliq (brodalumab) and PDE4 inhibitor Otezla (apremilast) represent newer oral and biologic options with slightly distinct mechanisms from older TNF inhibitors. The integrin inhibitor Brenzys (etanercept) and IL-23 inhibitor Tremfya (guselkumab) are newer originator biologics. Biosimilars Inflectra (infliximab) and Enbrel (etanercept) offer cheaper versions of established biologics.

Does Otezla work for scalp psoriasis?

Yes, Otezla improves both skin and joint psoriasis, including scalp involvement, for many patients. Over a third achieve 75% or greater skin clearance at 4 months including visible scalp improvement. Being an oral pill, its effects extend beyond just local application. However, combining with topical steroids, vitamin analogs and salicylic acid medicated shampoos boosts outcomes for resistant scalp psoriasis.

Is the new pill for psoriasis better than biologics?

The latest oral pill Sotyktu produces comparable skin clearance to the top biologics but avoids injections. However, biologics remain unique in also improving joint inflammation and nail changes unlike oral medications. Neither class helps everyone equally however. Individual factors determine ideal treatment choices rather than one option being inherently superior for all patients. Combining modalities leverages the best from both oral and biologic options.

In Conclusion

After decades relying solely on messy ointments, vitamin analogs and chemotherapy pills for psoriasis, patients now enjoy an explosion in treatment options – from convenient oral pills like Otezla and Sotyktu to targeted biologic injections. Emergence of biosimilars also increases access to costly biologics. Persisting research uncovering immunological underpinnings of psoriasis encourages development of therapies blocking specific inflammatory mediators driving this complex condition.

While our understanding of optimal treatment selections and sequencing continues evolving, patients already benefit enormously from reduced adverse effects and sustained remissions from newer agents. Moving forward, strategic early intervention tailored to each individual may hopefully profoundly impact long-term outcomes. For now, an era of unprecedented optimism and momentum promises more treatment advances translating into improved patient quality of life.

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