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    The oral pipeline for psoriasis

    Psoriasis: The oral pipeline

    Oral treatment for moderate-to-severe psoriasis has not kept pace with biologic therapies, despite the recent FDA approval of apremilast (Otezla, Celgene). There is a need for safe, effective long-term oral psoriasis therapies, researchers wrote in their review, published June 2015 in the Journal Expert Opinion on Emerging Drugs.

    There is an important place, however, for oral treatments like apremilast in the care of psoriasis patients, according to Joel Schlessinger, M.D., president of LovelySkin.com and a dermatologist practicing in Omaha, Neb.

    “Apremilast has become a useful alternative for patients who either aren’t willing or aren’t able to use the injectable new forms of treatment for psoriasis or are not topical treatment candidates,” Dr. Schlessinger says.

    Two bright spots on the oral pipeline horizon, according to the dermatologist, include medications with fumaric acid, which has been used successfully in Europe to treat psoriasis patients, as well as Janus kinase, or JAK, inhibitors.
    “JAK inhibitors are also an exciting area of potential exploration in not only the treatment of psoriasis but also alopecia areata, and many other conditions,” Dr. Schlessinger says.

    “Generally speaking, the benefits of injectables that are available are superior to oral treatments that are available but that doesn’t mean that oral treatment isn’t respected. It just means that many patients will try injectables before they try apremilast, and the apremilast is generally used in situations where the psoriasis isn’t quite as prevalent or PASI score is lower than necessary for injectables to be approved or if there are some other health conditions that are important to avoid injectables,” he says.

    Price challenges

    The big problem with the existing psoriasis treatments, including oral therapies, is price, according to Dr. Schlessinger.
    “Price has been extraordinarily challenging for many insurers and most if not all patients. The existence of patient assistance programs has been a challenge because to some degree of the interplay between insurance companies and pharmaceutical companies,” he says.

    “Oral treatment is modestly less expensive than the injectable treatments, with a significant decrease in efficacy in comparison. We have tried to get several people on the oral treatments with minimal success. The limitations for many insurance companies are affecting our patients’ access.”

    NEXT: Pipeline lineup

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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