In a session at AAD 2022, George Han, MD, PhD, associate professor, department of dermatology, Zucker School of Medicine at Hofstra/Northwell, reviewed various treatment options for patients with psoriasis.

After reviewing recent psoriasis research, Dr Han said the following are oral medications in the pipeline for psoriasis:

• Deucravacitinib (TYK2 inhibitor);
• Piclodenison (small molecule that binds the GI protein–associated A₃ adenosine receptor);
• Fumaric Acid Esters;
• EDP 1815;
• KD025;
• LP0200;
• Upadacitinib; and
• Ropsacitinib(PF-06826647).

Specifically, for deucravacitinib, Dr Han explained this treatment “has the potential to fundamentally change the narrow therapeutic windows seen with JAK inhibition due to selectivity for inflammatory TYK2 pathway.”

Next Dr Han said piclodenison “induces an anti-inflammatory response via deregulation of the Wnt and nuclear factor κB signal transduction pathways, leading to down regulation of proinflammatory cytokines, including IL-17 and IL-23.”

For fumaric acid esters, Dr Han said this has been used to treat psoriasis for over 60 years. He said dimethyl fumarate is the active component, although this is only commonly used in Europe.

Dr Han said fumaric acid esters are “effective for most types of psoriasis except nail psoriasis and psoriatic arthritis.”

He then explained that EDP 1815 affects the gut microbiome, is not absorbed and has no interactions with other medications, and there is only early phase data with modest improvements (mean PASI reduction 16-21%).

Next, Dr Han said KD025 targets inhibition of Rho-associated kinase (ROCK) 2 and regulates both IL-17 and IL-10.

Of important note, LP0200 is a pre-clinical treatment, but Dr Han said it is a “completely novel concept.” He said it is a small molecule cytokine blockade that affects protein to protein interactions and binds to the IL-17A homodimer while preventing interactions with its receptor.

“Upadacitinib has been approved in the EU for treatment of psoriatic arthritis,” he said.

Finally for Ropsacitinib(PF-06826647), he explained that this is a TYK2 inhibitor that Pfizer is developing. Currently, Dr Han explained a high dose is required for clinical effect. It is currently being used in psoriasis trials, and based on data so far, primary outcome measures are PASI90.

Dr Han noted the following as another future option:

JNJ-38518168 (a histamine H4 receptor antagonist).

Before concluding his study, Dr Han reviewed phototherapy and asked is there “anything new for phototherapy?”

He said that older data showed psoriasis cleared in 2-3 months depending on frequency, but newer data suggests patients acheive 75% clearance.

According to Dr Han, at-home NBUVB devices cost between $3000-$5000. Further, he explained newer phototherapy devices can be programmed with various treatment regimens.

Although beneficial, Dr Han said patients sometimes face barriers to phototherapy treatment. He said some patients are not able to get to the office, have trouble receiving approval for home phototherapy, and potentially face medicolegal concerns.

Reference:
Han G. Psoriasis: Topical therapy, oral therapy, and phototherapy. Presented at: AAD Annual Meeting; March 25-28, 2022; Boston, MA.