New treatments help psoriasis sufferers find relief

By Graham Lanktree

Abby Freidman's life has been tough since she was diagnosed with psoriasis at the age of nine. No drug seemed able to banish the flaky red plaques that cover 90% of her body during a serious flare-up. The 26-year-old Winnipegger says she was the kid "who got pointed out by adults to other adults" because of her appearance.

A recent quality of life survey of psoriasis sufferers by Psoriasis Support Canada found that an overwhelming 87% are still relying solely on older topical treatments; only 6% felt satisfied with treatment. This is worrying since there are some powerful new therapies for psoriasis that can help patients manage symptoms and get their lives back.

IT'S BIOLOGICAL
The most promising new treatment option is biologics, gene-based therapies that suppress the psoriasis patient's overactive immune system. "Biologics work well, are safe and are the best option for treating psoriasis," says Dr Wayne P Gulliver, a psoriasis specialist at Memorial University. He prescribes UV light therapy as an add-on.

In 2006 Ms Friedman suffered a horrendous flare-up, her nails fell out, her skin flaked off and it hurt to move. Her dermatologist decided to try her on alefacept (Amevive), a new biologic drug injected in 12-week cycles, followed by a break. After starting it she says her psoriasis all but disappeared. "For six months on Amevive I had no symptoms at all," she says. Her symptoms came back, but they're better controlled now.

However, the cost of the drug may prove prohibitive. Ms Friedman says her insurance company pays 80% of the $40,000 cost and the manufacturer foots the rest to make its product viable. Last month, the American Academy of Dermatology released new guidelines emphasizing use of biologics in the treatment of both psoriasis and psoriatic arthritis (available online at www.aad.org/pm/science/guidelines.html).

MONITOR COMORBIDITIES
"Most dermatologists won't be doing the regular screening that psoriasis patients need," says Dr Gulliver. "This is where GPs and FPs come in. They can see if the patient is developing any of the comorbidities associated with psoriasis."

The most important of these is psoriatic arthritis, which they have a 20-30% greater risk of developing. Then there's heart disease, which is 5-10% more common among psoriasis patients, and diabetes and hypertension, which are 20% more common.

"If you have a group that is 20% more likely to develop one of these diseases, it's not something to take lightly," says Dr Gulliver. He notes that psoriasis patients usually die 10 years younger than the general population and as much as 20 years early if their psoriasis started when they were really young. "I've had emails from patients saying 'I don't know what to ask or look for.' This is what we tell them: 'Get checked out regularly for comorbidities and make sure you're maintaining a healthy lifestyle.'"

If psoriasis patients smoke or are obese they tend to have more severe forms of the disease. It's paramount for physicians to work toward changing these characteristics and behaviours.