Treatment Update: Plaque Psoriasis

A round up of recent research results on plaque psoriasis treatment with itolizumab, apitherapy, and ponesimod.

Sustained Remission with Itolizumab Treatment in Patients with Plaque Psoriasis

There is an unmet need for psoriasis therapies that provide long-term remission. Itolizumab is a humanized recombinant anti-CD6 monoclonal antibody shown to be effective in psoriasis. Researchers recently reported on a patient who achieved long-term remission after receiving treatment with itolizumab in a phase 2 clinical trial. At baseline, the patient’s Psoriasis Area and Severity Index (PASI) was 12.2, and Physician's Global Assessment (PGA) score was 3. After 8 weeks of treatment, the patient achieved 97 percent improvement in PASI and continued to have ≥ 90 percent improvement, initially for 4 weeks (follow-up phase), and later for 20 weeks during the follow-up extension phase. The patient continued to visit the hospital after the final study visit. PGA results during the visits revealed sustained response for 4 years and 5 months after stopping itolizumab treatment. Based on these findings, the researchers suggested that itolizumab could be therefore an important treatment option for moderate to severe psoriasis, with potential to provide long-lasting remission.

Source: Clinical and Experimental Dermatology

Apitherapy for the Treatment of Recalcitrant Localized Plaque Psoriasis

No universal consensus about optimal modality for treating recalcitrant localized plaque psoriasis (RLPP) is available. To evaluate the immunological and clinical therapeutic effect of using apitherapy in the treatment of RLPP, investigators randomized 50 patients with RLPP to receive apitherapy (n&thinsp;=&thinsp;25) and placebo (n&thinsp;=&thinsp;25) every week for up to 12 weeks. Both treatments were injected into lesions at weekly intervals for a maximum of 12 treatments. Following up was 6 months later. Tumor necrosis factor-alpha (TNF-α) level was measured at pre-study and at week 12. The researchers reported finding a significant difference between the therapeutic responses of RLPP to the apitherapy and placebo groups (p<0.001). In the apitherapy group, complete response was achieved in 92% of patients. There was statistically significant decrease in TNF-α in the apitherapy group compared to the placebo group. No recurrence was observed in the apitherapy group. Based on these results, the researchers concluded that apitherapy is effective and a safe treatment for recalcitrant localized plaque psoriasis, when other topical or physical therapies have failed.

Source: Journal of Dermatological Treatment

Oral Ponesimod for the Treatment of Plaque Psoriasis

Researchers assessed the efficacy, safety, and tolerability of ponesimod, an oral, selective, reversible modulator of sphingosine 1-phosphate receptor 1, in patients with moderate to severe chronic plaque psoriasis. Over nearly 2 years, patients with psoriasis area and severity index (PASI) scores higher than 10 were enrolled into a multicentre double-blind, phase 2 study. They received 20 mg or 40 mg ponesimod or placebo once daily for 16 weeks. Those with at least 50 percent reduction in PASI score at 16 weeks and who were receiving ponesimod were randomized again to receive maintenance ponesimod therapy or placebo until week 28. The primary endpoint was reduction in PASI score from baseline of at least 75 percent (PASI75) at week 16. Of 326 patients initially randomized (20 mg ponesimod n=126, 40 mg ponesimod n=133, and placebo n=67) PASI75 was achieved at week 16 in 58 (46·0 percent), 64 (48·1 percent), and nine (13·4 percent), respectively. The treatment effect was significant for the two ponesimod doses (both p<0·0001). Of 219 patients who entered the maintenance period, PASI75 was achieved by week 28 in 35 (71·4 percent) of 49 who continued on 20 mg ponesimod and 41 (77·4 percent) of 53 on 40 mg ponesimod, and in 19 (42·2 percent) of 45 who swapped from 20 mg to placebo and 19 (40·4 percent) of 47 from 40 mg to placebo. Ponesimod was associated with dyspnea, raised liver enzyme concentrations, and dizziness. Based on these results, the researchers concluded that significant clinical benefit was seen at week 16 that increased with maintenance therapy.

Source: The Lancet