The Future of Psoriasis: Improving Efficacy, Access, and More

The biologic revolution in psoriasis may only be getting started.

In a presentation at the Noah Worcester Dermatological Society meeting in Quebec City, Quebec, Ronald Vender, MD, made eight predictions for the future of psoriasis treatments, with impacts ranging from efficacy to affordability and convenience.

Dr. Vender identified eight areas where he anticipates significant advancements in the future:

• Personalized medicine
• Next-generation biologics
• Combination therapies
• Longer-acting formulations
• Non-invasive delivery
• Biosimilars and affordability
• Immune tolerance induction
• Integration with digital health

PERSONALIZED MEDICINE

Dr. Vender discussed how advancements in genetic and biomarker research could identify which biologics a patient is most likely to respond to, optimizing efficacy and minimizing side effects.

“If we can do a blood test or a skin biopsy and say, ‘OK, you're an IL-17 phenotype or an IL-23 phenotype,” that would be a good thing,” Dr. Vender said.

Meanwhile, innovations in drug delivery systems could allow for more precise dosing based on individualized patient metabolism, he added.

NEXT-GENERATION BIOLOGICS

Research into previously less understood immune pathways involved in psoriasis could lead to the development of biologics targeting different cytokines or immune cells, Dr. Vender noted.

Additionally, bispecific antibodies engineered to target two different antigens or pathways simultaneously could increase treatment efficacy and reduce risk of resistance, he said.

“Bimekizumab could be considered a bispecific, blocking IL-17A and blocking IL-17F, but what sort of we're meaning here is a molecule that has a TNF on one part and an anti-IL-17 in another—OK, that's potential,” Dr. Vender said.

COMBINATION THERAPIES

Using two biologics together could provide synergistic effects in certain cases, Dr. Vender said, adding that combining biologics with small molecule inhibitors—such as JAK inhibitors—also could enhance treatment outcomes.

Dr. Vender said he had explored using ustekinumab with “a little sprinkling” of adalimumab every few months, but that it was no more effective.

“The [effective] combination that we saw were patients that may have psoriasis-formed dermatitis and are on an anti-IL-23 plus maybe on dupilumab or they could be on omalizumab and a biologic for their psoriasis as well,” he said. “There are some case reports of two anti-psoriatic biologics, but we don't find it's necessary.”

LONGER-ACTING FORMULATIONS

Extended-release biologics would allow or less frequent dosing, and Dr. Vender noted that this would improve patient adherence and quality of life. He cited one company, Apogee, that has been able to extend half-lives of biologics and will start a clinical trial this summer called ORCA.

“They have taken the risankizumab-like molecule anti-IL-23, they changed the FC portion, and we may be able to dose it twice a year,” Dr. Vender said. “They also have access to an anti-IL-17 like that. My only concern with that is that there is an [adverse event] from the anti-IL-17 and you have that long, long [release, so] how are you going to get out of it? So that's on hold right now. But we are starting that study coming up this summer.”

NON-INVASIVE DELIVERY

Advances in drug delivery technology could allow biologics to be administered either orally or via transdermal patches instead of via injections, Dr. Vender noted.

Additionally, nanoliposome carriers could deliver biologics more efficiently to targeted sites, enhancing efficacy and reducing systemic side effects, he said.

BIOSIMILARS AND AFFORDABILITY

The development and approval of more biosimilar drugs could make biologic treatments more affordable and accessible to a broader population, Dr. Vender noted, adding that innovations in biologic manufacturing to lower production costs also could make treatments more accessible.

“If the price of a biologic that you would inject, let's say, every 3 months was the same price as a cream,” he said, “wouldn't you put everybody on a biologic?”

IMMUNE TOLERANCE INDUCTION

Dr. Vender noted that research is ongoing into therapies that could induce immune tolerance to psoriasis antigens, potentially leading to long-term remission or even a cure.

INTEGRATION WITH DIGITAL HEALTH

Integration with digital health tools, such as wearable devices, could allow for real-time monitoring of disease activity and treatment response, enabling more timely adjustments to therapy, Dr. Vender said.

Additionally, artificial intelligence applications could reach the point of being able to analyze patient data to predict flares and optimize biologic therapy schedules, he said.

“ChatGPT is fantastic and it works very, very well,” Dr. Vender said. “That's how I did this whole presentation. That's not true.”