At first, Kathie McIver thought she was allergic to her job. The floral designer had a persistent rash on her hands, which a dermatologist suspected was a contact allergy. But after several years, she received a much more serious diagnosis: psoriasis, an autoimmune disease in which the immune system signals skin cells to regenerate much more quickly than normal. Most frequently, this results in raised, sometimes painful red patches on the skin, and an overabundance of peeling skin. “I felt helpless and embarrassed,” Kathie says. “My skin looked like it had been burned, and I could see people’s reaction. Sometimes I just wanted to crawl under a table.”
For years, Kathie had limited success managing her psoriasis with light therapy, which exposes the skin to ultraviolet rays that slow down cell growth. But, as many psoriasis sufferers find, the treatments eventually stopped working. Then, one night about six years ago, Kathie and her then-husband were dozing on the couch when they woke up to a TV ad about a clinical study for psoriasis sufferers at a medical center in Nashville, not far from their home in Jackson, Tenn. She enrolled, and noticed relief within a month. The disappearance of her symptoms, or “clearance” as it’s known in psoriasis terms, has persisted to this day.
“It’s one of the top five blessings of my life, up there with my three children,” Kathie says. “My life has turned around. I used to skip so many events, but now I can do anything.”
A New Class of Treatments
At the end of her five-and-a-half-year clinical trial, Kathie learned she’d been on Stelara, which was approved by the U.S. Food and Drug Administration in September 2009 and was greeted with much excitement in the psoriasis community.
In clinical studies of the drug, nearly 70 percent of psoriasis patients experienced 75 percent clearance of their symptoms. Between 40-50 percent had 90 percent clearance, a result “unprecedented in psoriasis,” says Bruce Bebo, director of research and medical programs for the National Psoriasis Foundation.
Stelara is one of several treatments for psoriasis classified as “biologic,” injectable drugs that focus on the immune response that causes the skin reaction. While biologics have been a breakthrough in psoriasis treatment since their appearance in 2002, they are not without risks. Because they target the immune system — albeit in different ways — they can make the body more vulnerable to infection.
“There is also a theoretical risk for developing cancer,” says Bebo. “Part of what the immune system does is protect you from viruses, and in a lot of cases it stops cancer from starting. We don’t really know yet what that risk might be long-term.”
A Complex Prescription
That’s one reason that doctors weigh a patient’s case, medical and family history and risk factors carefully when prescribing treatment for psoriasis. They must weigh the severity of the disease, and how that affects a patient’s life, with the risks of a drug that affects the immune system.
“The first decision point is the impact of the disease on the patient,” Bebo says, “including the amount of body surface covered, and how the disease impacts the quality of life.”
The National Psoriasis Foundation (NPF) defines moderate psoriasis as covering 3-10 percent of the body, and severe psoriasis as affecting more than 10 percent. But patients who suffer from psoriasis on their extremities like hands, feet and genitals, which are more sensitive, are treated more aggressively, as are patients with large, diffuse areas of psoriasis as opposed to smaller localized areas.
For milder cases of psoriasis, topical treatments and light therapy are also options. For some patients, topical steroids provide at least temporary relief. For others, Vitamin D creams help to slow down skin regeneration.
The NPF also recommends psoriasis sufferers maintain a healthy weight, avoid tobacco and alcohol, and control stress as a means of managing the condition, but also because a growing body of evidence shows a link between psoriasis and cardiovascular health.
While Kathie McIver’s success with Stelara has lasted for years, there’s no evidence that biologics are less likely than prior psoriasis treatments to stop working after a period of time. Changing treatments periodically is likely to be necessary for patients for the foreseeable future.
“The immune system eventually figures out a way around the drug, and a new pathway to cause psoriasis,” Bebo says. “So the more options a physician has, the better. That’s one reason the National Psoriasis Foundation is always advocating for more treatments.”
And there are some on the horizon. Perhaps most promising is the development of even more targeted biologics, including one that blocks only one of the two immune cell proteins targeted by Stelara.
“We’re getting more specific with these targets, which is going to save bigger chunks of the immune system that you need to fight infection,” Bebo says. Several such drugs are already in the second and third phases of their clinical trials, and could emerge as treatment options as soon as the next few years.
“It’s a really hopeful time if you have psoriasis,” says Bebo.
For more information on types and treatments of psoriasis, visit the National Psoriasis Foundation’s website here.