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Getting To Psoriasis Through The Immune System

Posted Aug 24 2008 1:49pm
ANNOUNCER: Human skin is the largest organ in the body, and when something goes wrong, the results can be devastating. Just ask any of the estimated 5.5 million Americans who suffer from psoriasis.

DAVID PARISER, MD: It can be a very mild condition with a few little scaly patches on the elbows or knees, or it can be quite severe, involving large, widespread areas of the body with red, scaly, itchy and sometimes painful patches and plaques.

ANNOUNCER: It is a condition that is now understood to result from a malfunctioning of the immune system.

KENNETH GORDON, MD: We don't know exactly what sets off the immune system in psoriasis. Clearly there are genetic factors that make some people more susceptible to the disease. They'll start having this reaction that cause the skin to develop a hyperproliferative state where the cells start growing too quickly. And therefore that'll show up as psoriasis.

ANNOUNCER: But a new type of treatment called biologic therapy is now offering new hope for people living with psoriasis with moderate to severe symptoms.

DAVID PARISER, MD: What is new and exciting for patients with psoriasis and for the physicians who treat them is we now have a new class of biologic drugs which have been specifically developed and engineered to treat psoriasis by specifically targeting the defective immune response, and this will give both physicians and their patients a wider choice of medications in order to help them treat the disease.

ANNOUNCER: Unlike traditional treatments, biologics work by treating not just symptoms but by getting to the core problem of abnormal T-cell activity, thus modifying the disease process itself.

DAVID PARISER, MD: In order to develop the skin lesions of psoriasis, there has to be an activation of the T-cell by an antigen-presenting cell. The T-cell is the actor that produces the inflammation through release of cytokines and various other substances. Biologics work by blocking the interaction of the antigen-presenting cell and the T-cell, or by blocking the inflammatory cytokines that's the product of the T-cells after they have been elaborated.

KENNETH GORDON, MD: Remissions in psoriasis can be induced by deactivating the T-cells, the primary immune cells that cause psoriasis. And by eliminating these cells and reducing their activity, hopefully patients will attain long-term remissions of their disease.

ANNOUNCER: Biologic therapy could be a welcome departure from other treatment options.

DAVID PARISER, MD: Previous treatments for psoriasis that is moderate to severe have included systemic medications, such as cyclosporin and methotrexate, both of which work very well, but which have severe serious organ toxicity associated with it. That means bad side effects. Another treatment for moderate to severe psoriasis has been a form of light treatment called PUVA, which is a treatment that works well but is inconvenient. Patients have to come into the office sometimes two or three times a week for extended periods of time, and that has side effects too.

KENNETH GORDON, MD: Biologics, with their specificity, don't affect other parts other body and therefore have a significant advantage.

DAVID PARISER, MD: There is some theoretical possibility of increasing infections, but that has not been seen in clinical trials.

ANNOUNCER: Biologics, also used to treat conditions including Crohn's disease and rheumatoid arthritis are given either through the skin or directly into the bloodstream. One called Amevive is given in a doctor's office through weekly injections for 12 weeks then stopped till needed.

KENNETH GORDON, MD: I think that people will find as they are able to be on these medications for time -- have their psoriasis controlled -- people will be willing to go for once a week for a few minutes to their physician's office in order to get the medication.

DAVID PARISER, MD: What's important with Amevive is that it may produce a remission that will last for extended period of time, whereas with methotrexate and cyclosporin and even with some of the other biologics in the early studies, this long-term remission that's seen with Amevive is not seen with the other drugs. So we do have a possibility with Amevive of being able to induce a period of remission, which means a time when patients won't have to be on any treatment.

ANNOUNCER: The biologics Enbrel and Raptiva also show successful remission. These medications are self-injected at home and must be taken on a continuous basis to be effective. Still the end results seem to offset the initial adjustment to any of the biologics.

KENNETH GORDON, MD: There's a score that we call the PASI that is our definition of what is psoriasis improvement, and a 50 percent improvement in that score is thought to be a very clinically significant response. With biologics, the great majority of patients will reach their PASI 50, that 50 percent improvement in the psoriasis score, which is the clinically acceptable rate of psoriasis remission.

ANNOUNCER: Biologics promise to deliver not only longer-lasting results, but ultimately more significant relief for people living with psoriasis.

DAVID PARISER, MD: As I look back over my almost thirty years of practice, at the patients that I have helped the most and whose lives I have significantly impacted, a significant group of those have been patients with severe psoriasis who have been able to get better with existing treatments. It's nice now to have newer and better drugs that are able to do that more efficiently.

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