“Thirty years ago, psoriasis patients were hospitalized for very long periods and underwent topical treatments. Since 2000, biologics have revolutionized clinical practice. They are the first drugs that allow us to treat patients suffering from inflammatory disease in conditions of safety, efficacy and continuity. These are drugs that must be used throughout life for their efficacy and reduction of adverse events. Thanks to biologics, hospital admissions have shrunk because patients can be managed at home. Psoriasis is a treatable disease, but being chronic, like diabetes and hypertension, it needs continuous treatment and biologics have their place in this. ” Paolo Dapavo, dermatologist at the Città della Salute e della Scienza University Hospital of Turin, speaking at the sixth Talk of ‘Allies for Health‘, the portal dedicated to medical-scientific information created by Novartis.
Title of the debate: ‘Biological drugs: an opportunity to be seized‘, which was also attended by Ugo Viora, president of Anap Onlus, and the journalist Silvia Bencivelli. What is the difference between biological and biosimilar drugs? How have clinical practice and the doctor-patient relationship changed? These are the issues addressed during the meeting, strictly online for the anti-Covid rules, during which it emerged that thanks to biological drugs it is now possible to customize therapies, in particular for psoriasis.
“Psoriasis is a systemic inflammatory disease – recalls Dapavo – and contrary to what was thought in the past, it is not limited to the skin, but involves the joints and may be associated with other conditions. Psoriatic patients are generally overweight, with high blood pressure and blood sugar, metabolic syndrome and psychological problems related to the disease. Therefore the evaluation of the patient cannot be limited to the skin “.
Biological drugs are different, depending on the severity of the disease. “We have three categories of biologics available – underlines the dermatologist – namely antibodies anti Tnf-alpha, anti interleukin-17 and anti interleukin-23. For a person with psoriasis, joint pain and morning stiffness, it is indicated anti-Tnf-alpha antibody. In the case of very widespread and severe psoriasis, which requires a rapid response, anti-interleukin-17 is more suitable. These are drugs administered subcutaneously, but not all patients prefer this type of treatment. The patient with moderate psoriasis who does not want to undergo injections, the anti interleukin-23 with a prolonged administration over time is the most recommended therapy. We are in the golden year of biological therapy, but the task of the clinician, relating adequately with the patient, is to make the best choice for the patient when it is needed “.
Not all patients can access this type of treatment, however they are increasingly informed about new therapeutic options. “Thanks also to the work of the associations – explains Dapavo – and to a new type of communication with social networks, they are more informed about therapeutic availability. In the past, the disease was manageable only with creams, fortunately this is no longer the case. I ask the patient what is his work activity, because from what he does in everyday life and from the commitment of his psoriatic disease I try to convince him of my therapeutic proposal. Apart from the tests that are required to enroll the patient in biological therapy, very important is the therapeutic alliance between doctor and patient for adherence to treatment, essential for a chronic disease. A recent statistic showed that 50% of patients throw away their dermatological prescriptions. With biological therapy, the dermatologist’s task becomes easier. When the patient sees that the treatment is successful, he is more motivated to continue it “.
However, the patient with psoriasis “is not easy to convince – continues the dermatologist of the Aou City of Health and Science of Turin – He asks us: does the drug work? Is it safe? How long will I have to take it? The concept of chronicity of therapy is the most difficult to accept, I think of women who would like to experience a pregnancy. I usually put a time limit of 1-2 years. After that, remission occurs. This helps a lot. ”
During the talk there was also talk of ‘switch’ da originator a biosimilare come best practice, both in terms of appropriateness and sustainability to free up useful resources to give patients greater access to innovative therapies. When asked if the biosimilar can be considered a biologic of series B, Dapavo has no doubts: “This is absolutely not true. The biosimilar – he points out – is the right drug in a certain category of patients with certain clinical conditions that he can receive. maximum benefit from this category of drugs, rather than others, at a precise moment of its therapeutic process “.
From an economic point of view, “biosimilars are an opportunity – adds Dapavo – since they cost less because it is biological drugs that have lost patent protection. But this is not a limit. Indeed, it must be a further enrichment because it allows us to treat more patients. I don’t talk to the patient about biosimilars, but about anti-TNF. For psoriasis there is only one category of biosimilars, the anti-TNFs, the first which have been replaced by other completely similar drugs even if there is no equality. When I propose a biosimilar I do not ask myself the problem that I am giving my patient a less effective drug that has less impact on his disease, because if it has been approved and in my opinion the patient must be treated with anti-TNF, he deserves that type of drug ” .
And about the future of psoriasis treatment, Dapavo is sure: “My idea – he says – is that the space acquired by biosimilar, biological and biotechnological drugs will be increasingly large. A patient who is comfortable with biological therapy reduces hospital visits and blood tests, so he is not forced to waste hours of work to perform visits and checks. We have reached such a level of efficacy and safety that it seems difficult to think of anything even more effective, but I would be happy to be surprised.
In closing, the pandemic experienced by patients with psoriasis. “During the Covid emergency we obtained the automatic renewal of the treatment plan which has an annual expiration. This prevented patients from coming to the hospital. The home delivery of biological drugs, where it was possible, was an excellent initiative. Just as telemedicine proved to be very useful because it allowed us to reduce a number of bureaucratic issues “, concluded Dapavo.