2023-04-17 16:56:06
Severe itching combined with pain, burning sensation, tightness and dryness of the skin, cracking, scaling, redness and even bleeding. These are the symptoms that patients with a moderate or severe form of plaque psoriasis: circa 500 thousand Italians, out of a total of almost two million compatriots affected by this chronic inflammatory pathology, characterized by phases of remission alternating with phases of worsening. The “vulgar” (or “plaque”) type is the most widespread: it generally arises in the second or third decade of life and it then requires lifelong therapy. “It can be a very disabling disease and compromise both the quality of life and productivity in the workplace, as well as social and emotional relationships – he recalls Piergiorgio Malagoli, head of the PsoCare Unit at the IRCCS Policlinico San Donato in Milan —. It is estimated, in fact, that more than 90% of patients complain of a heavy impact on emotional well-being. This is why it is important to have effective strategies that are well tolerated and comfortable to take».
The new medicine
A further step forward in the therapeutic equipment available to specialists comes from the results of the POETYK PSO-1 and POETYK PSO-2 studies (phase three, the last before the official approval of a new treatment), which indicate the significant and sustained efficacy of a new drug, deucravacitinib (recently approved by the European drug agency EMA), on multiple key objectives, including the possibility of obtaining skin completely free from lesions and the ability to reduce the intensity of symptoms. The molecule is well tolerated: the most common adverse reaction is upper respiratory tract infection, which is not serious. «Deucravacitinib is a selective tyrosine kinase 2 inhibitor (TYK2) with a unique mechanism of action, which is part of a new class of small molecules he adds Antonio Costanzoprofessor of Dermatology and director of Dermatology at the IRCCS Humanitas Clinical Institute in Milan —. It is an oral therapy whose administration is very easy: once a day. It also does not require laboratory monitoring. It manages to block only one protein, TYK2, essential for some receptors underlying the pathogenesis of psoriasis. At the same time, it does not inhibit other proteins such as JAK1, JAK2 or JAK3. All of this translates into excellent efficacy of the treatment, which also has good levels of safety and tolerability».
Different types of psoriasis
Psoriasis is a chronic disease, from which there is no cure, but which is now being controlled better and better. In recent years, in fact, new medicines have arrived which have made it possible to achieve a previously unthinkable goal: have clean skin, free from reddish patches and covered with scales (typical manifestations of the pathology). There are several variations and the lesions tend to appear on some parts of the body than others (elbows, knees, scalp, lower back, hands and feet). «We now know that it does not only concern the skin, but it is a disease with systemic involvement, i.e. associated with numerous other pathologies, first of all psoriatic arthritis – explains Malagoli -. But the list is long and includes the association, documented with increasing precision, with some metabolic diseases (including diabetes, obesity and metabolic syndrome), the increased cardiovascular risk, non-alcoholic fatty liver diseaseinflammatory bowel disease and uveitis (an eye disease).’
Different therapies
A moderate-severe form of plaque psoriasis cannot be treated only with topical treatments or with conventional systemic therapies: however, several new biological drugs are available to treat it which have proved to be useful even in the most severe cases. «In Italy there is a problem of limited access to highly specialized medicines – adds Malagoli -. At the moment, only a few reference healthcare facilities, authorized at national level, administer the most innovative therapies. Dermatologists in the area hardly recommend medicines that they cannot prescribe to their clients. This situation can create problems, especially for patients affected by the most severe forms of psoriasis. «Another unmet need of Italian patients is to achieve long-term disease control – concludes Costanzo -. For several years we have had very advanced treatments available, such as monoclonal antibodies or biological drugs. However, these are injection therapies that require a cold chain. Therefore their administration can be very complex. Having more “comfortable” oral treatments available, which have a good level of efficacy and safety, can be a great advantage».
April 17, 2023 (change April 17, 2023 | 5:05 pm)
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