I don't know if this transcript has been posted on the forum before - it is an interesting read.
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LoginPsoriasis: Are We Closer to a Cure?
ANNOUNCE: Psoriasis is a difficult disease to treat. And most patients experience skin flare-ups no matter what treatment they're on. That's why doctors are excited about new types of drugs that affect the body's immune system and may radically change the way psoriasis is treated.
GAIL ZIMMERMAN: What's exciting today is that we have over 40 new therapies being investigated for psoriasis. This is unprecedented. Now we have some therapies that are being developed that are specifically targeted at addressing the problem, the biological problem, that is causing psoriasis.
ANNOUNCE: Traditionally, the goal of psoriasis treatment has been to clear the patient of the skin lesions that characterize the disease. This is done with topical therapies applied to the skin, phototherapy, which uses ultraviolet rays and systemic therapies that are taken in pill form.
ALICE B. GOTTLIEB, MD; Topical therapies include topical corticosteroids, topical Vitamin D and Vitamin A analogues. And of course, there are emollients of keratolytics. In terms of phototherapy, there is ultraviolet B phototherapy and ultraviolet A in combination with psoralen, which is called PUVA. And in terms of systemic treatments, there is cyclosporine, acitretin and methotrexate. All of these can be used in combination. The combinations are not FDA-approved necessarily, but we do in fact do that.
GAIL ZIMMERMAN: Some of the therapies that we have today, though effective, can be very inconvenient and difficult to use. Some require visiting the doctor's office three to four times a week for many months. This is often very difficult for people who cannot leave their work or who travel. There are also therapies that produce some significant short-term side effects that can make them sick, can make the patient sick. And they have to stay home while they're taking the therapy.
ANNOUNCE: So the goal for researchers has always been to find effective treatments that are easier for patients to take. The most promising new approach is based on the discoveries that pinpointed the source of psoriasis in the immune system.
JIM KRUEGER, MD: The immune system is a system in the body that for most part exists to fight off infectious agents of various kinds. What's going on in psoriasis is that there is overactivity of one arm of the immune system, that is, the cellular immune system. And essentially what happens is that one class of immune cell called the lymphocyte enters the skin and sets up an inflammatory reaction that produces scaling, erythema, thickness in the skin which are the cardinal signs of a psoriatic lesion.
ANNOUCE: It's been known for some time that the immune system plays a role in psoriasis, and older medications like cyclosporine and methotrexate work by blocking certain parts of the immune system. But while this may help psoriasis, it can create other problems.
JIM KRUEGER, MD: These are good drugs when used in the right setting, but they are also drugs that have a lot of side effects that particularly become apparent with long-term use. The real problem to their use is not their initial effectiveness, but it's the long-term toxicities that are associated with administration of those agents.
ANNOUNCE: These toxicities can harm organs like the liver and kidneys, and can also cause birth defects. But the newer "biologics" will avoid these problems by narrowing their effects on the immune system to the activity of one type of cell, the T-lymphocyte.
JIM KRUEGER, MD: There were a series of experiments that became available that showed or suggested that the T-lymphocyte was the main culprit underlying psoriasis. So over the last five years, there have been a series of new drugs or biologics that have been tested in patients with psoriasis, all of which are directed in some way to decrease the activity of this specific type of immune cell. That in theory will reduce the long-term and short-term side effects that are seen with these medications.
ANNOUNCE: A number of agents are under investigation. Among the most promising are Remicade, Amevive, Xanelim and Enbrel. Two of the agents Remicade and Amevive have been shown to cause long-lasting remissions in many patients.
ALICE B. GOTTLIEB, MD; You can treat with alefacept, stop cold turkey, and a high proportion of patients maintain clearance for a long time in the absence of continuous treatment. So both alefacept and infliximab are remittive treatments. And in fact, the remissions with those two drugs lasts longer than with the current gold standard of remittive treatment, which is PUVA. So that in a way, alefacept and infliximab raise the bar and establish a new height of long lived remission that we haven't even had to date.
ANNOUNCE: So far biologic agents are living up to their promise of reducing side effects.
GAIL ZIMMERMAN: I have talked to several people who are on the clinical trials of these new immune system modulators. They speak very highly of them. So far it seems to have cleared their psoriasis very well. They have minimum side effects from taking the drugs. So we're very hopeful.
To be continued.............
AussieGuy
