According to current studies, more than 8 million Americans have psoriasis. In a 2021 cross sectional study, the prevalence of psoriasis in the U.S. was 3% for individuals over 20 years of age. An immune-mediated disease, psoriasis affects nearly 125 million individuals worldwide. This chronic condition causes inflammation in the body resulting in raised plaques, redness, itchiness, burning, and stinging. The plaques are formed due to an overactive immune system resulting in a scaly pile-up of skin cells, often found on the elbows, knees, and scalp. Although the pathogenesis in unclear, several concepts have been hypothesized. The most common hypothesis being the “activation of T cells, inflammatory cells, and keratinocytes leading to the release of cytokines. The plaque formation is due to the hyper-proliferation of the keratinoctytes.” It has been reported that this chronic disorder may have predispositions and triggering environmental factors such as bacterial infections, trauma, and even drug-induced, although none have been confirmed. Other forms of psoriasis include guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis, and psoriatic arthritis.
Psoriasis negatively impacts the quality of life, as commonly seen among young children and women. As there is no cure for psoriasis, it is the healthcare team’s goal to increase pliabliity of the skin and decrease or clear any erythema, papules, plaques, and scales, to improve the quality of life. With the ongoing expanding market of psoriasis treatments, topical agents are the first-line drugs of choice before the introduction of phototherapy or a systemic agent. These topical agents range from corticosteroids, emollients, tar, typical retinoids, anthralin, to topical calcineurin inhibitors, although results may take a few months. More advanced treatments include methotrexate, cyclosporine, and newly-discovered biologics. The variability of treatment options is so vast, topical corticosteroids can be further divided in potency categories. Psoriasis treatment, unfortunately, becomes a game of trail and error for many individuals.
With biologics being the revolutionary drugs of the decade, these immunomodulators come with their fair share of cons. Although less toxicity is observed towards the kidneys and liver with quicker and efficient results, patients leave themselves susceptible to infections, exacerbation of existing cardiovascular diseases, demyelinating diseases, and even blood dyscrasias.
One of the most commonly administered biologics for psoriasis is infliximab (Remicade). A TNFA-alpha blocker, infliximab is only available through an infusion. In spite of the fact that a single, reconstituted-vial of the drug costs rougly $1,000, a single treatment session ranges between $3,000 and $5,000. Completing the entire regimen can cost well over $50,000 for the year as patients must return at weeks 0, 2, and 6 and every 8 weeks thereafter. Infliximab has FDA-approved biosimilars, however, costs range between $500 and $1,000. Biologic usage has promising results but is reserved as a last-line treatment for refractory patients.
According to current studies, more than 8 million Americans have psoriasis. In a 2021 cross sectional study, the prevalence of psoriasis in the U.S. was 3% for individuals over 20 years of age. An immune-mediated disease, psoriasis affects nearly 125 million individuals worldwide. This chronic condition causes inflammation in the body resulting in raised plaques, redness, itchiness, burning, and stinging. The plaques are formed due to an overactive immune system resulting in a scaly pile-up of skin cells, often found on the elbows, knees, and scalp. Although the pathogenesis in unclear, several concepts have been hypothesized. The most common hypothesis being the “activation of T cells, inflammatory cells, and keratinocytes leading to the release of cytokines. The plaque formation is due to the hyper-proliferation of the keratinoctytes.” It has been reported that this chronic disorder may have predispositions and triggering environmental factors such as bacterial infections, trauma, and even drug-induced, although none have been confirmed. Other forms of psoriasis include guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis, and psoriatic arthritis.
Psoriasis negatively impacts the quality of life, as commonly seen among young children and women. As there is no cure for psoriasis, it is the healthcare team’s goal to increase pliabliity of the skin and decrease or clear any erythema, papules, plaques, and scales, to improve the quality of life. With the ongoing expanding market of psoriasis treatments, topical agents are the first-line drugs of choice before the introduction of phototherapy or a systemic agent. These topical agents range from corticosteroids, emollients, tar, typical retinoids, anthralin, to topical calcineurin inhibitors, although results may take a few months. More advanced treatments include methotrexate, cyclosporine, and newly-discovered biologics. The variability of treatment options is so vast, topical corticosteroids can be further divided in potency categories. Psoriasis treatment, unfortunately, becomes a game of trail and error for many individuals.
With biologics being the revolutionary drugs of the decade, these immunomodulators come with their fair share of cons. Although less toxicity is observed towards the kidneys and liver with quicker and efficient results, patients leave themselves susceptible to infections, exacerbation of existing cardiovascular diseases, demyelinating diseases, and even blood dyscrasias.
One of the most commonly administered biologics for psoriasis is infliximab (Remicade). A TNFA-alpha blocker, infliximab is only available through an infusion. In spite of the fact that a single, reconstituted-vial of the drug costs rougly $1,000, a single treatment session ranges between $3,000 and $5,000. Completing the entire regimen can cost well over $50,000 for the year as patients must return at weeks 0, 2, and 6 and every 8 weeks thereafter. Infliximab has FDA-approved biosimilars, however, costs range between $500 and $1,000. Biologic usage has promising results but is reserved as a last-line treatment for refractory patients.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246333/
https://pubmed.ncbi.nlm.nih.gov/23565631/
https://pubmed.ncbi.nlm.nih.gov/32121574/