Along with the perils of industry support (see main story), controversies facing dermatologists include the impact of biologic drugs for psoriasis, the efficacy of treating actinic keratoses (AKs) for cancer prevention, the advancement of pay-for-performance programs, the rise in Mohs utilization rates and the role of food allergies in childhood eczema, experts say.
San Antonio - Although biologics for psoriasis have received perhaps inordinate attention, they represent a significant leap forward for dermatologists and patients, says Abby Van Voorhees, M.D., assistant professor of dermatology and director of the psoriasis and phototherapy treatment center at the University of Pennsylvania, Philadelphia.
For starters, biologics have helped provide a better understanding of patients' experiences and their disease burden, she says. As a result of a 1998 National Psoriasis Foundation quality-of-life survey, Dr. Van Voorhees says, dermatologists were surprised to learn how negatively psoriasis impacted respondents' daily living, from sleeping and sexual relationships to hand and foot problems that compromised older patients' ability to live independently (Krueger G, et al. Arch Dermatol. 2001 Mar;137(3):280-284).
"Nobody was prepared for the fact that at the time of the survey, 10 to 20 percent of patients stated that they were actively contemplating suicide as a consequence of their disease," she tells Dermatology Times.
Biologics, moreover, have helped elucidate the role of T cells, tumor necrosis factor (TNF)-alpha and, more recently, interleukin (IL)-12 and -23 in the pathogenesis of psoriasis, Dr. Van Voorhees says. Additionally, biologics have expanded the therapeutic armamentarium while teaching new lessons about traditional treatments, she says.
Compared to earlier options, she says, "Biologics have demonstrated efficacy in the treatment of psoriasis." Perhaps equally important is the fact that clinical trials for biologic drugs have been far more rigorous than those for cyclosporine and its predecessors. Many of the latter trials were small and not double-blinded, she notes.
Dr. Van Voorhees says biologics represent "the beginning of questioning the true effectiveness of our medications." She also says, however, that the conventional systemic therapies can be effective agents as well, and that they will continue to serve a very important role in the care of psoriasis patients. "We now can use these older agents in more specific situations, thereby minimizing some of their potential risks."
Disclosure: Dr. Van Voorhees has served as an adviser, speaker and/or investigator for Amgen, Astellas, Abbott, Genentech, Incyte, Centocor and Warner Chilcott.
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