Biologic treatments to treat the physical symptoms of psoriasis

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More than 4.5 million adults in the United States have been diagnosed with psoriasis and 21 percent of those have moderate to severe psoriasis. This chronic condition, characterized by thick, red, scaly plaques that itch and bleed, not only makes the activities of daily life difficult, but also can affect a person's emotional well being.

Recently, researchers have developed biologic treatments which not only treat the physical symptoms of psoriasis but also can help improve a patient's quality of life.

Speaking today at the ACADEMY '05, the American Academy of Dermatology's (Academy) summer scientific session in Chicago, dermatologist Mark Lebwohl, M.D., professor of dermatology, Mount Sinai School of Medicine, New York, N.Y., discussed how these biologic therapies are offering patients with psoriasis new hope.

"Psoriasis poses as much, if not more, of a threat to quality of life than other common major medical conditions," Dr. Lebwohl said. "It affects everything in a patient's daily life from deciding what clothes to wear to how well he or she sleeps at night."

Biologic treatments target the precise immune responses involved with psoriasis, leaving most of the immune system intact. These drugs include etanercept, infliximab, adalimumab, alefacept, and efalizumab.

A recent study evaluated the health related quality of life in patients with severe psoriasis who were treated with infliximab. In the double-blind study of 249 patients, patients were randomly assigned to receive infusions of either a three or five milligrams per kilo dose of infliximab or a placebo. Patients completed the Dermatology Life Quality Index (DLQI) at the beginning of the study and after week 10. At week 10, the patients on the three milligram per kilo dose of infliximab scored 84 percent on the DLQI and the patients on the higher dose scored 91 percent.

"The DLQI is an assessment of the quality of life in adults with dermatologic disease," Dr. Lebwohl said. "The higher the DLQI score, the greater the impact on a patient's quality of life and there is a strong correlation between these scores and the percentage of improvement in the patient's disease."

Some people with psoriasis also develop a condition called psoriatic arthritis, a long-term condition that produces joint inflammation. Psoriatic arthritis can affect the wrists, knees, ankles, finger and toe joints, the spine and the sacroiliac joints (joints in the lower back where the spine connects with the hips).

In a recent study of etanercept, patients with psoriatic arthritis received either injections of etanercept or a placebo for 24 weeks. Efficacy and safety were evaluated at four, 12 and 24 weeks and then at 12 week intervals thereafter. At 12 weeks, 59 percent of the patients receiving etanercept had an improvement in joint response, compared with 15 percent of the placebo patients.

"The biologic treatments can alleviate symptoms and slow the progression of disease," Dr. Lebwohl said. "While not all treatments are suitable for every patient, a dermatologist can determine which one may be right for an individual."

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