Psoriatic Disease Drugs in the Pipeline

Finding an effective treatment for psoriatic disease (PD) often requires trial and error. Because people experience PD differently, there's no one-size-fits-all approach. What's more, as your disease progresses, you may need new medications or dosages to keep your symptoms under control.

There's a wide variety of medications for treating PD, which is necessary, given that people who live with it experience a wide variety of symptoms. This article explains why PD sometimes can be challenging to manage, describes the medications approved to treat it, and previews those that are being researched.

How PD Is Treated

Psoriasis and PsA are chronic diseases, and there's no cure for either of them. The goal of treatment is to relieve symptoms and prevent the disease from getting worse. There are five broad categories of medications commonly used to treat PD.

Topical Medications

Topical medications, which are applied directly to the skin, are typically the first-line treatment for skin psoriasis.

There are many options:

• OTC treatments, such as salicylic acid, coal tar, keratolytics, and moisturizers
• Prescripion topical steroids
• Non-steroidal medications such as Dritho-Creme (anthralin); Dovonex (calcipotriene) and Vectical (calcitriol), which are both vitamin D derivatives; Tazorec (tazarotene), which is a retinoid; and more
  

Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) decrease inflammation, joint swelling, and pain. They include over-the-counter (OTC) medications such as ibuprofen (Advil and Motrin, for example) and aspirin, as well as prescription-strength NSAIDS known as COX-2 inhibitors.

Corticosteroids

Corticosteroids reduce severe inflammation in joints and tendons. They're given by mouth or injection, usually for short periods of time to treat flare-ups. Healthcare providers don't usually prescribe steroids often for this condition because plaques sometimes worsen after treatment is stopped.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) primarily are used to treat rheumatoid arthritis. They're sometimes prescribed for inflammation and pain when NSAIDs don't work well enough.

DMARDs also can help slow—sometimes even stop—ongoing damage to joints and tissues caused by PsA.

The ones prescribed most often are:

• Plaquenil (hydroxychloroquine). Note this medication is not recommended for people with skin psoriasis, as it can cause flares.
• Rheumatrex (methotrexate)
• Azulfidine (sulfasalazine)
• Imuran (azathioprine)
• Otezla (apremilast)

Biologics

These are medications made from living material rather than chemicals. They work by preventing the immune system from overreacting. Biologics are given by injection or infusion.

There are several categories of these drugs:

• Tumor Necrosis Factor-Alpha (TNF-alpha) Inhibitors: Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab)
  
• Interleukin 12 and 23 (IL-12, IL-23) Inhibitor: Stelara (ustekinumab)
• Interleukin 17 (IL-17) Inhibitors: Cosentyx (secukinumab), Siliq (brodalumab), Taltz (ixekizumab)
• Interleukin 23 (IL-23) Inhibitors: Skyrizi (risankizumab-rzaa), Ilumya (tildrakizumab-asmn), Tremfya (guselkumab)
• T-cell Inhibitor: Orencia (abatacept)
  

PD Drugs in Development

There are several medications in the pipeline for treating PD. As with all medications, each must go through three phases of study before the Food and Drug Administration (FDA) will consider approving it:

• Phase 1 trials, during which the safety of a medication is studied
• Phase 2 trials, which measure how effective a drug is
• Phase 3 trials, in which side effects are monitored and effectiveness is compared to similar drugs on the market

Among the PD medications in development:

Deucravacitinib (BMS-986165)

Deucravacitinib is an oral medication that's similar to Humira. In phase II trials it was found to be effective for up to 75% of study participants by the 12^th week. Phase III trials have found deucravacitinib to be equal to or better than several other PD medications and placebo, in terms of effectiveness, safety, or immune system response.

For example, the results of a major set of trials of the drug called the PrOgram to Evaluate the efficacy and safety of deucravacitinib, a selective TYK2 inhibitor (POETYK) were presented at the 2021 meeting of the American Academy of Dermatology.

The POETYK research compared deucravacitinib to Otezla and found it to be more effective after 16 weeks and 24 weeks. The manufacturer's application for review has been accepted by the FDA, with an anticipated decision in late 2022.

Netakimab (BCD-085)

BCD-085, or Patera, is a biologic and type of monoclonal antibody being tested for people with psoriasis and psoriatic arthritis. In phase I trials, researchers determined the safest dose for people with psoriatic disease. In phase II, researchers found the majority of patients were meeting the American College of Rheumatology Criteria for improvement.

In Phase III, researchers plan to evaluate the effectiveness and safety of BCD-0085 in comparison to a placebo. Phase lll should be fully completed by November 2022.

Bimekizumab (UCB4940)

This medication has been through all phases of trials for the treatment of moderate to severe plaque psoriasis.

Previous research shows promising response rates and symptom improvement. The drug is designed to selectively and potently neutralize both IL-7A and IL-17F, two proteins involved in the inflammatory process.

Following phase IIb, researchers determined that 46% of the patients who took the drug were showing at least 50% symptom improvement for both joint and skin, and the improvement continued through week 48. Bimekizumab is currently in phase III clinical trials and the manufacturer has announced that they will apply for FDA review in late 2022.

Piclidenoson (CF101)

As with several other psoriasis medications, Piclidenoson targets IL-17 and IL-23. As of April 2021, a phase 3 trial to compare it to Otezla was announced, with results expected in the last quarter of the year. Announcements about the results are expected in 2022.

Summary

A number of medications for treating psoriasis and PsA are in the works, including four that have reached the final phases of research.

A Word From Verywell

Everyone who has PD experiences it differently. Some have mild symptoms that do not affect their quality of life, while others must face severe and debilitating symptoms every day.  

If you have PD, work with your healthcare provider to find the best treatments for you. It may be frustrating if you're having trouble landing on the medications that will relieve your symptoms, so keep in mind the future for treating PD is bright. Researchers are hopeful that one day PD can be cured, or at the very least, more people will be able to reach remission.