Raptiva Targets T-Cells

Raptiva is a man-made antibody. It goes against T cells, the quarterbacks of the immune system. It doesn't kill the T cells -- instead, it blocks T cells from moving from the blood into the skin.
Mark Lebwohl, MD, of Mt. Sinai School of Medicine in New York, and colleagues treated nearly 600 moderate-to-severe psoriasis patients with two different doses of Raptiva. After 12 weeks of treatment:
28% of high-dose patients (2 mg/kg body weight injections once a week) had at least 75% improvement.
22% of low-dose patients (2 mg/kg body weight injections every other week) had at least 75% improvement.
"Continued [Raptiva] therapy provided continued benefit," Lebwohl and colleagues report. "In addition, extending the [Raptiva] treatment from 12 to 24 weeks resulted in improved responses in many subjects who did not initially have improvement of 75% or more."

Enbrel: From Arthritis to Psoriasis

Enbrel is a man-made protein that blocks a chemical messenger called TNF (tumor necrosis factor). Blocking TNF quiets the abnormal immune responses seen in arthritis -- and in psoriasis.
Craig L. Leonardi, MD, of St. Louis University, and colleagues tested three different doses of Enbrel in 652 adult patients with moderate-to-severe psoriasis. After 24 weeks of treatment:
59% of high-dose patients (50 mg injections twice a week) had at least 75% improvement -- 55% reported "clear" or "almost clear" status.
44% of medium-dose patients (25 mg injections twice a week) had at least 75% improvement -- 39% reported "clear" or "almost clear" status.
25% of low-dose patients (25 mg injections once a week) had at least 75% improvement -- 26% reported "clear" or "almost clear" status.
"Rapid clearing of skin lesions is an important aspect of effective psoriasis management and may correlate with the patient's satisfaction with treatment," Leonardi and colleagues write. "After two weeks of treatment, [Enbrel] produced statistically significant and clinically meaningful improvements in patients' global assessments of disease and in the quality of life."

New Options In Psoriasis Treatment

Not so long ago, psoriasis sufferers had few options. Now three already-available drugs offer relief from the agonizing skin disease.
The new drugs are Enbrel, Raptiva, and Amevive. All are "biological" drugs -- they use recent scientific breakthroughs to target specific body functions.
Psoriasis is an autoimmune disease; the new drugs block harmful immune responses. Amevive and Raptiva were approved earlier this year as psoriasis treatments. Enbrel was approved in 1998 to treat rheumatoid arthritis. Enbrel's manufacturer, Wyeth, a WebMD sponsor, has filed for formal approval as a psoriasis treatment.
Separate clinical studies of psoriasis patients treated with Enbrel and Raptiva appear in the Nov. 20 issue of The New England Journal of Medicine. So does an editorial by Thomas S. Kupper, MD, of Brigham and Women's Hospital in Boston.
"At this point, there are insufficient data to support claims that one of these agents is superior to another," Kupper writes. "There may be groups of people who have a better response to one or the other of these agents."
All of these drugs likely must be taken for long periods of time -- perhaps for life. Because they interfere with the immune system, there is a danger that they will raise patients' risk of infections and maybe even cancer. It's not clear how the drugs will work over years and years of treatment. But in the short term, all have remarkable safety records. That's particularly true for Enbrel, which has been used in more than 150,000 patients -- including long-term safety studies in 2,000 patients.

Sunshine and Psoriasis

Brief, regular periods of exposure to natural sunlight can improve or clear psoriasis in some people. This approach to treating psoriasis is called climatotherapy. Sunburn should be avoided because it can make psoriasis worse. Exposure to sunlight is not recommended for people who are sun-sensitive. Sun exposure can cause aging of the skin. An annual medical checkup is advised because sun exposure can increase the chance of skin cancer.

Plaque Psoriasis

Plaque psoriasis is the most common form of psoriasis. It is characterized by raised, inflamed (red) lesions covered with a silvery white scale. The scale is actually a buildup of dead skin cells. The technical name for plaque psoriasis is psoriasis vulgaris (vulgaris means common). Plaque psoriasis may appear on any skin surface, though the knees, elbows, scalp, and trunk are the most common locations. Sometimes the patches of infected skin are large, extending over much of the body. The patches, known as plaques or lesions, can wax and wane but tend to be chronic. These can be very itchy and if scratched or scraped they may bleed easily. The plaques usually have a well-defined edge and, while they can appear anywhere on the body, the most commonly affected areas are the scalp, knees and elbows. However, if the scalp is involved, you may develop psoriasis on the hairline and forehead. The actual appearance of the plaques can depend on where they are found on the body. Plaques found on the palms and soles can be scaly, however they may not be very red in color. This is due to the thickness of the skin at these sites. If the plaques are in moist areas, such as in the creases of the armpits or between the buttocks, there is usually little or no scaling. The patches are red and have a well-defined border. Chronic (or common) plaque psoriasis affects over 90% of sufferers. It appears usually on the scalp, lower back, elbows, arms, legs, knees and shoulders. It is very much an adult condition.

Get the Facts on Psoriasis

Psoriasis is a chronic skin condition affecting approximately 4.5 million people in the United States.
New skin cells grow too rapidly, resulting in inflamed, swollen, scaly patches of skin in areas where the old skin has not shed quickly enough.
Psoriasis can be limited to a few spots or can involve more extensive areas of the body, appearing most commonly on the scalp, knees, elbows and trunk.
Psoriasis is not a contagious disease.
The cause of psoriasis is unknown, and there currently is no cure.
Psoriasis can strike people at any age, but the average age of onset is approximately 28 years. Likewise, it affects both men and women, with a slightly higher prevalence in women than in men.
Approximately 30 percent of people with psoriasis are estimated to have moderate-to-severe forms of the disease.Psoriasis can be a physically and emotionally painful condition.
It often results in physical limitations, disfiguration and a significant burden in managing the daily care of the disease.
Psoriasis sufferers may feel embarrassed, angry, frustrated, fearful, depressed and, in some cases, even suicidal.