New systemic psoriasis treatments keep raising bar
The ongoing rush of safe, highly effective systemic agents for psoriasis has created a new era in which substantial numbers of patients may achieve complete clearance, said an expert at the American Academy of Dermatology 75th Annual Meeting, held here.
In the year 2000, said Craig Leonardi, M.D., two authors called complete skin clearance an unrealistic expectation for patients with psoriasis.1
“The fact is that right now, we have many drugs that are so far different from what we used to use even five years ago that complete clearance is a realistic possibility in many of our patients,” says Dr. Leonardi. He is adjunct professor of dermatology at St. Louis University and a St. Louis, Missouri-based dermatologist in private practice.
As a reference point, he says, “Finally, we have numbers for how methotrexate performs in modern measurement systems.” In a well-designed 120-patient trial with modest dose escalation, 41% of patients achieved psoriasis area and severity index (PASI) 75, and 66% achieved PASI 50 at week 16.2 “This settles the issue of how well methotrexate indeed performs,” Dr. Leonardi says. Although no study patients developed pancytopenia, “It’s always an issue in the back of my mind. At any one time I’ll have hundreds of patients on methotrexate.” Based on research in rheumatoid arthritis, he says, risk factors include renal disease, hypoalbuminemia, infection, age and concomitant medication use.