The daily tablet that can wipe out the misery of psoriasis
AGROUND-breaking tablet that treats psoriasis could mean an end to the debilitating pain and embarrassment suffered by thousands of Britons who have the disfiguring skin condition. After promising results in clinical trials in America, the NHS is now considering the use of Apremilast in the UK and doctors have welcomed the move.
‘This is a huge step forward in potentially treating a much greater proportion of people suffering from psoriasis,’ says Dr Richard Warren, consultant dermatologist at Salford Royal NHS Foundation Trust and The University of Manchester.
‘Many patients are worried about the serious side effects associated with existing therapies, and trials suggest this is a very safe drug that will require minimal monitoring.’
Psoriasis is a common condition in which the immune system produces skin cells too quickly, leading to a build-up of scaly pink patches on the elbows, knees and hands, though they can appear anywhere on the body.
About three per cent of the UK population suffers, affecting up to 1.8million people. One in 100 suffers an extreme form of the condition that may require hospitalisation. Celebrity sufferers include socialite Kim Kardashian and singer Art Garfunkel.
Psoriasis can appear at any age but usually first develops in adults under 40. A third of psoriasis sufferers go on to develop tenderness, pain and swelling in the joints and connective tissue, a condition known as psoriatic arthritis.
Psoriasis varies greatly in severity. While some patients suffer only minor irritation, for others it dramatically reduces quality of life. Depression and low self-esteem are common and psoriasis on the hands or feet can make many everyday tasks difficult, while psoriatic arthritis can cause disability.
First-line treatment is usually moisturisers, shampoos and coal-tar preparations while more intense therapies include steroid drugs, which can have wide-ranging and unpleasant side effects if used long-term.
Ultra-violet light – similar to a sunbed – has proved effective in a percentage of patients, though the benefits last only about six weeks before another course is needed.
Current treatments for psoriatic arthritis involve injectable drugs that inhibit tumour necrosis factor (TNF), the substance that triggers the inflammation to occur, but carry serious side effects such as nausea, infections and liver problems.
The new treatment works by inhibiting phosphodiesterase 4 (PDE4), an enzyme in immune system cells, causing an antiinflammatory effect.
Clinical trials of 1,500 adults with active psoriatic arthritis by US drugs company Celgene have shown Apremilast to be safe and effective, significantly reducing inflammation and joint pain and swelling compared to a placebo.
Few patients (up to two per cent) showed adverse reactions – such as diarrhoea, nausea, weight loss and headache.
Studies on psoriasis patients have found that a third experienced a 75 per cent improvement in skin problems. Kristian Reich of the SCIderm Research Institute and Dermatologikum in Hamburg, who carried out the study, said of the drug: ‘I see this as a prime candidate for future management of psoriasis that allows us to treat a range of patients, including more moderate cases earlier on.’
First marketed as Otezla, it was approved in March for use in America and it is hoped the drug will become available in Europe later this year.
South of the Border, the National Institute for Health and Care Excellence is appraising its use for psoriatic arthritis, with hopes that it will eventually also be available for general psoriasis.
One patient keen to try the drug is Robert Hoyle, 53, an ex-serviceman from Bradford who now works in a warehouse and fears his condition will progress into psoriatic arthritis. He suffered minor symptoms in his late 30s but dismissed them as sweat rashes for years, until psoriasis was eventually diagnosed.
His current treatment is Diprosalic, a thick Vaseline-like substance which he finds doesn’t rub in easily and has never fully cleared up his skin.
‘If the new drug is as effective as other treatments I’ve tried but without the side effects, I’d happily try it, as would many others I know,’ says Robert, who has had to take several months off work over the past seven years due to the condition.
‘The ointments can be messy, uncomfortable, and time-consuming. A pill that gives relief from the scaly skin and constant itching would transform my life.’