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Apremilast Approved for Psoriasis Treatment

Curr Opin Rheumatol; May 2016; Ritchlin, Krueger

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Apremilast, an oral agent, is among several novel immunologic pathways pivotal in the development of pathobiology of psoriasis and psoriatic arthritis (PsA), a new study found. These discoveries catalyzed a search for new treatment targets resulting in many new therapies now available. Helper T cells that secrete interleukin-17 (TH17) along with CB8+ cells, innate lymphocyte cells, and gamma delta T cells are important in the pathogenesis of psoriasis and PsA, researchers explained. Recently, agents that target TH17, the TH17 receptor, and interleukin-23 (antip 19) have been approved or are in clinical trials. Apremilast was approved for the treatment of both psoriasis and PsA. They also reported:

• Apremilast demonstrates moderate efficacy with an excellent safety record.

• Targeting interleukin-23 with antibodies to p19 is another approach with encouraging results in psoriasis.

Citation: Ritchlin CT, Krueger JG. New therapies for psoriasis and psoriatic arthritis. Curr Opin Rheumatol. 2016; 28(3): 204-10. doi:10.1097/BOR.0000000000000274.

Commentary: Since the development and approval of the three TNF-a agents, adalumumab, etanercept, and infliximab for moderate to severe psoriasis and the subsequent approval over 6 years ago for the IL-12/23 agent, ustekinumab, a wide range of new agents, both investigative and approved, have been developed. This has come about as a direct result of new pathways/cytokines being discovered in the immunopathogenesis of psoriasis (ie, IL-17 and IL-23). Likewise in psoriatic arthritis, these two key molecules are playing a similar role in the biologic drug development, both oral and injectable.

This paper by two leading experts in the field is an excellent review of the three IL-17 agents, two of which (ie, Ixkizumab and secukinumab) are now available for psoriasis, and lxekizumab, still to be approved for psoriatic arthritis. The third IL-17 agent, brodalumab, despite being withdrawn from further clinical trials, is likely to be approved by November 2016. The three IL-23 agents are all still in clinical research studies with excellent clinical results being noted today and with the likelihood of them being available for psoriasis therapy late in 2017 or early 2018. The new oral agent, apremilast, is FDA approved and currently available for psoriasis and psoriatic arthritis. Another oral agent, tofacitinib, is also to be approved in both. —Alan Menter, MD

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