ISTANBUL, TURKEY – The current intensive period of new drug development in psoriasis is cause for enthusiastic celebration by patients and physicians alike. That is, except for one glaring research gap.
Almost all of the promising drugs now in phase-II or -III clinical trials are systemic agents aimed at the minority of psoriasis patients with more severe disease. There’s not nearly as much in the pipeline for the many patients with mild psoriasis who are most appropriately treated with topical therapy, Dr. Hervé Bachelez observed at the annual congress of the European Academy of Dermatology and Venereology.
Dr. Herve Bachelez
Indeed, he identified only two promising topical agents advancing through the developmental pipeline: Pfizer’s tofacitinib, a small-molecule Janus kinase inhibitor under study in both topical and oral formulations, and Anacor’s AN2728, a boron-containing molecule that inhibits phosphodiesterase-4 (PDE-4).
Industry’s lack of enthusiasm for developing new topical agents is difficult to understand, given that 84% of all U.S. prescriptions written for psoriasis in 2009 were for topical agents, according to IMS. Moreover, patients clearly believe there is a major unmet need for new and better topicals: a recent survey of 2,151 European psoriasis patients and their dermatologists found that only 45% of patients on topical therapy were satisfied with their treatment. And a mere 35% of dermatologists rated current topical treatments as satisfactory (J. Dermatolog. Treat. 2013;24:193-8).
The great bulk of the action in psoriasis drug development now is focused on injectable biologics and oral small molecules. Among them are three interleukin-17 inhibitors: Novartis’ secukinumab, Amgen’s brodalumab, and Eli Lilly’s ixekizumab. Celgene is developing apremilast as an oral PDE-4 inhibitor. Merck and Janssen Biotech are developing MK-3222 and CNTO 1959, respectively, as interleukin-23 inhibitors.
Dr. Bachelez, professor of dermatology and head of the inflammatory skin diseases unit at Saint Louis University Hospital, Paris, reported serving on the advisory boards of 10 pharmaceutical companies.