Drs Mark G. Lebwohl and Alice B. Gottlieb discuss future expectations in the treatment of plaque psoriasis.
Mark G. Lebwohl, MD: Based on the developments of the past several years and how the treatment armamentarium has expanded, what would you like to see emphasized in research development over the next several years? What do you think is realistically achievable?
Alice B. Gottlieb, MD, PhD: I’d like to see better efficacy in psoriatic arthritis. That may involve treating it even earlier than we treat it on average. That’s an area of opportunity. I’d like to see pills that do the same thing with the same safety profile. I’d like to see an oral anti–IL-23 or an oral IL-17 inhibitor that has the same efficacy and safety profile. Is it realistic? I don’t know. Maybe not tomorrow, but hopefully in the future. I’d like to see the cost of drugs go down, whether it’s for business and political reasons or because they found a cheap way to manufacture them, which would allow a lower cost and maintain a good profitability. I’d like to see more people getting access to them.
Mark G. Lebwohl, MD: I’ll add to that good list that the safety of the new drugs, particularly the IL-17 and also IL-23 blockers, is extraordinary. We used to warn patients about malignancy and infection every time we put a patient on a TNF [tumor necrosis factor] blocker. We don’t anymore. These drugs are much safer, but we could use more data regarding malignancy to settle that question. I’d like to see these drugs also reverse cardiovascular disease, which is increased by psoriasis. That will be true, but we need to prove it.
Alice B. Gottlieb, MD, PhD: Also, prevention of psoriatic arthritis. We treat children and young adults. Probably 20 or 30 years ago, I suggested to the folks who made infliximab that if you’re doing all these registries, why don’t you have a rheumatology exam once a year? Over time you will show a lower incidence of psoriatic arthritis. The answer was, “That’s a dumb idea, Alice.” But it was a good idea. Prevention of psoriatic arthritis is another goal.
Mark G. Lebwohl, MD: If we had a marker to identify who’s going to go on to develop psoriatic arthritis, that would absolutely change our treatment paradigms. That would be valuable information. I don’t know who told you that was dumb, Alice, but a lot of companies are looking for that magic molecule that will tell us you’ve got to be wary of psoriatic arthritis in this patient.
Alice B. Gottlieb, MD, PhD: There are some data from Israel, which has a national health system, a national database. [Yael Shalev] Rosenthal was the first author on it. They compared a population of psoriasis patients with no diagnosis with psoriatic arthritis over a number of years. They looked at who got new-onset psoriatic arthritis. From their database, it was clear that the patients on biologics who did better than the patients not on biologics had had a lower incidence of future psoriatic arthritis. That’s suggestive.
Mark G. Lebwohl, MD: Yes. With that, thank you for teaching us a ton about IL-17 blockers and psoriasis. I want to thank the audience for participating in this. Hopefully you learned a lot. Thank you very much.
Alice B. Gottlieb, MD, PhD: Thank you.
Transcript edited for clarity