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 the disease progresses new medications and dosages may be needed to keep symptoms under control.

There's a wide variety of medications for treating PD, which is necessary given people who live with it experiences a wide variety fo 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.

PD Defined

Psoriatic disease is an umbrella term for two separate autoimmune diseases:

Psoriasis causes patches of scaly skin called plaques on various parts of the body.
Psoriatic arthritis (PsA) causes inflammation in the joints.

Some people have only one PD condition, some have both. Around 30% of people who psoriasis eventually develop PsA.

Scientists in medical lab — sanjeri / Getty Images

How PD Is Treated

Psoriasis and PsA are both chronic diseases, meaning 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 skin, typically are 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); a vitamin D derivative; Tazorec (tazarotene), which is a retinoid; Vectical (calcitriol); 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 try not to prescribe steroids often because in the case of skin psoriasis, 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)

Acthar gel (respository corticotropin) is an injectable biologic that helps the body produce steroid hormones to regulate inflammation. It's used for short periods of time as an add-on to other PD treatment.

Recap

Treating psoriatic disease, which includes the skin condition psoriasis and psoriatic arthritis, can be challenging. Some people with PD have only one of these diseases, some have both, and nearly every experiences PD differently. There are five broad categories of medications used to relieve symptoms and prevent PD from getting worse.

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 as of the end of September 2021 are:

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.

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 III is currently in the recruiting stage and the study should be fully completed by January 2021.

Bimekizumab (UCB4940)

This medication has been through all phases of trials for the treatment of moderate to severe plaque psoriasis. It is scheduled to be considered for approval by the FDA on October 15. 2021.

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 percent 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.

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 that last quarter of the year.

Summary

A number of medications for treating psoriasis and PsA are in the works, including four that have reached the final phases of research and one that is expected to be considered for approval in October 2021.

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 one day PD can be cured, or at the very least, more people will be able to reach remission.