Photo Credit: Andrey Popov
In a commentary for the Journal of Investigative Dermatology, Joel M. Gelfand, MD, discusses psoriasis treatment, recent advances, and the potential for a cure.
At the Fall Clinical Dermatology Conference 2024, presenters discussing psoriasis focused on new treatment options, the impact of comorbidities, and advancing patient-centered care, specifically in underserved populations.
A separate commentary unrelated to the meeting published in the Journal of Investigative Dermatology examined topics in a similar vein, examining the current state of psoriasis treatment, recent advances, and the recognition of psoriasis as a systemic disease.
“The last 2 decades have witnessed unprecedented advances in the management of psoriasis with new drugs targeting TNF, IL-17, IL-23, PDE4, Tyk2, and the aryl hydrocarbon receptor,” Joel M. Gelfand, MD, wrote. “Some of these targets lead to profound and rapid clearance of psoriasis, and some lead to prolonged remissions measured in months and possibly years in a subset of patients who discontinue therapy.”
However, Dr. Gelfand notes that advances beyond the skin manifestations of psoriatic disease, including the association with cardiometabolic dysfunction, have not progressed at the same speed. This is despite “intense efforts” to examine these associations, he noted.
The Potential for a Psoriasis Cure
The commentary also examined what Dr. Gelfand called “provocative thinking” about a cure for psoriasis by 2035.
In this context, he discussed a perspective from Su Mar Lwin, MRCP, PhD, and colleagues, published in the Journal of Investigative Dermatology, in which Dr. Lwin and colleagues examined the factors involved in a potential cure for psoriasis.
Dr. Gelfand highlighted emerging data supporting the hypothesis from Dr. Lwin and colleagues, specifically noting that early treatment—within 1 to 2 years of disease onset—is tied to the best outcomes for patients with psoriasis. However, he also said that these data come from highly selected patients in clinical trials, with findings often modest in effect size and “may be confounded by several clinical and genetic risk factors that are not accounted for in these analyses.”
Working Toward “A Paradigm Shift” in Research
To examine whether early treatment of psoriasis of any severity can result in disease modification, Dr. Gelfand noted that “a paradigm shift in how clinical research is executed in the field of psoriasis” is needed.
Such a shift will require pragmatic trial designs, randomization, collaboration, and support from multiple partners, including governmental funding agencies, foundations, health systems, clinicians, “and, most of all, patients and their families.”
If successful, this effort toward a cure would produce a dramatic shift “in the care of at least 60 million affected people with psoriasis worldwide,” Dr. Gelfand wrote.
“Alternatively, if the null hypothesis is correct, we will be armed with new knowledge about the natural history of new-onset psoriasis of all levels of severity that will undoubtedly be necessary to determine which subsets of patients can be cured of their psoriasis as our basic knowledge and treatments continue to advance.”
