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Biologics hope to reach 8 million undiagnosed psoriasis sufferers

Posted on: 24 Mar 05


Despite almost 20 million global sufferers and comorbidities ranging from visible signs of infection to arthritis, there is no cure for psoriasis and public awareness of the disease remains low with up to 45% of sufferers undiagnosed. However, new biologic treatments and marketing campaigns are helping to bring psoriasis more into the public eye, to the benefit of all available products.

Plaque psoriasis, the most common form of psoriasis, is a chronic recurring skin disease that causes raised, red patches with silvery scales on top. This occurs because of an abnormally high rate of growth of skin cells and while the exact reason for this is unknown, contemporary wisdom suggests that a problem with the immune system plays a role.


Human skin cells normally mature and shed about every 28 days, however in psoriasis sufferers this cycle may take only three to six days. It is a relatively common condition, affecting 1-3% of the world's population and sufferers are often genetically predisposed to being affected. While psoriasis is rarely life threatening, it does often result in severe morbidity and disability. It is estimated that there are 18 million psoriasis sufferers in the seven major pharmaceutical markets with up to 16% of those developing psoriatic arthritis.


Psoriasis currently has no cure, thus current treatments seek to either manage the disease or prevent further outbreaks. It is also currently vastly under recognized with only 55% of sufferers thought to have been diagnosed. This leaves a very large proportion of psoriasis sufferers, most likely with a mild form of the disease, either self treating with over-the-counter medication or totally untreated.


Current therapies


If the epidemiology estimates for patient volume are applied to these figures, it shows that a total of over 8.1 million patients are either using non-prescription medication or no medication at all. However this situation will improve as awareness of psoriasis improves due to the extensive marketing campaigns for new biologic treatments entering the market.


"I think the awareness of psoriasis has increased tremendously recently... every year there's one or two big new exciting drugs, it's really been phenomenal, bringing more patients in to see us." - US opinion leader


As there is currently no cure for psoriasis, the goal of therapy is to clear each episode and prevent a recurrence for as long as possible. Doctors generally treat psoriasis in steps based on the severity of the disease, size of the areas involved, type of psoriasis and the patient's response to initial treatments.


In step 1, medicines are applied to the skin (topical treatment), step 2 uses light treatments (phototherapy), and step 3 involves taking systemic medicines that treat the whole immune system. Variations from this approach include combinations of therapy, which according to physician research are used in increasingly severe patients, with 45% of the most severe patients using a combination of pharmaceuticals and non-pharmacological treatment like phototherapy.


New biologic treatments


Unfortunately, over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. As a result, doctors often use a trial and error approach to find a treatment that works, and they may switch treatments periodically if a treatment does not work or if adverse reactions occur.


But ultimately the non-life threatening nature of psoriasis means that physicians are less willing to take risks with treatment options than for other diseases. Systemic treatments are only used on very severe patients and opinion leaders agree that biologics are also only warranted on the more severe patients.


"There's no question that there is a small percentage of patients who are sufficiently severe, and they've had a poor experience with other treatments, in whom a biologic is clearly justified." - US opinion leader


For severe cases of psoriasis, biologics are emerging as the best form of treatment. The current leading biologics are Biogen Idec's Amevive; Serono, Genentech and XOMA's Raptiva; Wyeth and Amgen's Enbrel and Johnson and Johnson's Remicade. Raptiva is approved for psoriasis in both the US and the EU, Amevive and Enbrel are approved in the US but have yet to be approved in the EU, while Remicade is currently undergoing phase III trials for psoriasis and psoriatic arthritis in both the US and EU. Psoriatic arthritis approval is significant due to the off-label prescribing possibilities for severe psoriasis patients.


Raising awareness


Research indicates that among physicians efficacy is weighted as the most important attribute, followed by side-effect severity. The perception among physicians of the importance of side effects in the biologics class may be attributable to the relatively unknown nature of these drugs. Despite some side effects, infection at the site of injection being the most common, biologics compare well with some other systemic treatments for severe psoriasis such as cyclosporine or methotrexate.


Ultimately, almost all treatments that work for the more severe form of psoriasis impact or target the immune system in some way. The pharmacological rationale behind biologics is that they are more targeted, and should spare the body broad side effects.


Maintenance of remission is another unmet need within psoriasis that these treatments aim to fulfill. However, only long-term use on the market can really prove the effectiveness of biologics in this attribute.


However despite the advances being made in treatment, perhaps the biggest challenge is raising awareness of psoriasis and therefore rates of diagnosis. Patient advocacy groups are also taking measures to improve both diagnosis and treatment rates. In fact, the American Academy of Dermatology is launching a public awareness campaign in early 2005 in the US, which coupled with the increased awareness brought about by treatment marketing campaigns, will no doubt help to tackle the ongoing problem of low diagnosis rates.


Related research:


·          Stakeholder Insight: Psoriasis - Biologics Impact Treatment Regimes Across the Globe

·          Addressing Pharma's R&D Productivity Crisis: Technological and Strategic Initiatives to Improve Core Drug Discovery Capabilities

·          Pipeline and Commercial Perspectives: Psoriasis and Atopic Dermatitis - Reimbursement the key as biologics and TIMs transform disease markets


Last updated on: 27/08/2010 11:40:18

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