Treatments for common inflammatory diseases, such as atopic dermatitis (eczema), alopecia areata, vitiligo, hidradenitis suppurativa, acne, and rosacea are being furthered by the research done on psoriasis.
Eczema and psoriasis are characterized by immune-mediated inflammation and abnormal keratinocyte differentiation. Because of their similarities, the therapeutics for eczema (in particular) have benefitted from continued psoriasis research.
“The first biologics, like alefacept, were only modestly effective, and they targeted the activation of lymphocytes. These agents were designed to target just a tiny fraction of the immune system, which ultimately allowed us to treat psoriasis much more effectively, Dr. Lebwohl says. Mark Lebwohl M.D., FAAD, Sol and Clara Kest professor and chairman of the department of dermatology at Mount Sinai School of Medicine, New York, New York says it was the realization of the critical importance of the IL-17 and IL-23 pathways that led to the development of numerous therapies that target and block only a very small part of the immune system. And this has resulted in extraordinary clinical outcomes with very few side effects.
Well-known psoriasis treatment, immunosuppressant Cyclosporine, worked well, but it makes patients more susceptible to cancers, opportunistic infections, as well as a host of other side effects. Current advanced treatment approaches include therapies that target individual molecules in the immune system and lead to the clearing of inflammatory skin diseases that are immunologically mediated, without disrupting the immune system as a whole.
As the only biologic currently approved by the U.S. Food and Drug Administration for eczema, dupilumab (Dupixent, Sanofi Regeneron Pharmaceuticals) is the first and only IL-4 and IL -13 antibody used for patients with eczema. Early results show that it can achieve dramatic clinical outcomes at the lowest dose. Following the success with dupilumab, a host of other biologic agents including tralokinumab (Leo Pharma) and lebrikizumab (Dermira) were developed to target IL-13, and are achieving positive clinical outcomes in trials with minimal side effects.
Dr. Lebwohl says. “The future is very bright for atopic dermatitis patients, as these new and exciting agents have been shown to help clear patients, particularly when recalcitrant to other tried therapies.”
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