Brad Glick, DO: New Agents in Psoriasis

In an interview with MD Magazine®, Brad Glick, DO, a dermatologist and principal investigator with GSI Clinical Research, detailed the most promising up-and-coming therapies in psoriasis and atopic dermatitis—and how they improve various aspects of patients’ conditions.

MD Mag: What are upcoming therapies for psoriasis and atopic dermatitis?

Glick: There's always a lot. I think right now—and as we'll talk about today—we have 11 drugs that are targeted therapies for treating psoriasis. So I think we have that down pretty pat. We certainly need to provide more education, not only to our patients, but also to our colleagues. I think that we need cost-effective agents. I think we need oral systemic agents that are almost, if not equally, as effective as biologics, with really nice safety profiles. Hopefully we can get those.

And certainly, not every patient who has psoriatic skin disease is going to get a systemic therapy. Certainly, patients with mild psoriasis who don't have a number of comorbidities, who don't have background psoriatic arthritis, are appropriate candidates for topical therapies.

And we have new ones on the horizon. For instance, there is something called an arrow hydrocarbon receptor agonist, a new generation product called tapinarof, which I think is unique. And what's unique about is, in the skin it actually decreases cytokines. It decreases the inflammation that we see associated with psoriatic skin disease.

So there are other topical therapies. There are new combination therapies that include topical vitamin D and topical corticosteroids that are on the horizon. We received a drug just this past year which is a unique agent, which includes a retinoid which is effective for psoriasis, but it can be a little bit irritating. And at the same time, in that fixed combination therapy it has a topical corticosteroid to balance out the consequences of both agents.

And so I think that is extremely unique to have in our topical therapy armamentarium.

Moreover, what I think is important on the horizon are even more targeted therapies. We’re getting close to, if you will the neck of the inflammation, so to speak, where we can really decrease those cytokines more specifically.

There's a drug that is coming to market called bimekizumab—it should be available hopefully to us in the next year or 2—which is specifically targeted to the component of the interleukin 17 group of cytokines. And so far, the preliminary data in its early trials appears to be quite, quite exceptional.

MD Mag: Is the benefit of these drugs the best-case outcome for patients with psoriasis or eczema?

Glick: I say to my patients and I say to my colleagues: the biologic therapies are fantastic, but they don't clear 100% of the patients, 100% of the time. But I must admit that we really are getting closer.

We used to say in the earlier days of our biologic therapies, getting close to about 20 years ago when they were most active in clinical trials—when they came out we would say, ‘we can get your skin clearer.’ But now we can say that, ‘we can get your skin clear.’

And we have agents right now that more than 50% of the time in the clinical trials have individuals with completely clear skin at the end of 1 year, and some of the even newer agents, the numbers are even more specific, where we're close to 70% of the patients being 100% percent clear at the end of 1 year.

And I have these conversations with my patients because we've really come a long way, and I think it provides a great deal of confidence for patients that are particularly down and out about their condition. As you know, anxiety and depression are very important parts of psoriatic disease. And we can really give patients a lot of hope that they can have significant improvement.

So the future looks bright.