Seeing Clear: What the Future Holds for Psoriasis

How unraveling more mysteries of the immune system may help guide better health outcomes for patients

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Light micrograph of a section through skin affected by psoriasis, a chronic skin disease causing inflammation and scaly lesions. Source: Biophoto Associates/Science Photo Library

Seeking a Way to Treat Psoriasis at its Source

“Let me remind you where we stood with psoriasis when I first started my work in dermatology,” said Kristian Reich, a dermatologist and professor at the Dermatologikum in Hamburg, Germany. “Patients were spending three or four weeks in the hospital, two or three times a year. What could we offer them?”

Just 20 years ago, Reich didn’t have a good solution for his patients battling psoriasis. The majority of patients didn’t respond to the available treatment options. It was clear that these treatments weren’t enough – and they weren’t addressing the disease at its source.

Scientists and researchers knew that psoriasis was more than just a skin condition. The problem came from a faulty immune system that sent the wrong signals and caused skin cells to grow too rapidly.

But their understanding of how that breakdown in communication happened wasn’t perfectly clear. It was like opening the hood of a car, seeing the machinery inside, but not knowing exactly how it all connected.

They needed an instruction manual to help them explore the problem and fix the broken part.

Whenever I ask my patients with psoriasis ‘what do you want?’ they say ‘I no longer want to see my disease’

Kristian Reich, professor at Dermatologikum in Hamburg, Germany

Searching for a Better Target

By the early 2000s, scientists were uncovering more answers about the source of psoriasis. They had identified a specific protein that had a role in the body’s immune response, and its discovery had spurred the development of new biologic medicines.

Biologics were a different type of treatment that addressed the faulty immune system, not with broad strokes, but with a targeted approach that aimed for the disease at its root cause.

With these new medicines, many patients began to see improvement in their psoriasis, but it also motivated scientists and researchers to seek more details to expand their manual and help more people to get relief from psoriasis.
 

The Journey from 75 to 100

“Whenever I ask my patients with psoriasis ‘what do you want?’ they say ‘I no longer want to see my disease’,” Reich says.

But what does no longer seeing the disease really mean? Doctors use a metric called the Psoriasis Area and Severity Index (PASI), to categorize a patient’s response to treatment. PASI 50 indicates a 50 percent improvement in clearance of scales and patches, PASI 75 indicates a 75 percent improvement, and a PASI 90 indicates a 90 percent improvement.

“Now, so many people are able to achieve PASI 75 that the goal is becoming PASI 100 – 100 percent improvement in psoriasis skin symptoms,” said Marek Honczarenko, M.D., Ph.D., a vice president of global immunology development at AbbVie.

To get there, scientists and researchers at AbbVie are working to shed more light on how the immune system works as they look for new targets that could lead to treatments for psoriasis with different mechanisms of action.

No matter which piece of the immune system they are exploring, it’s the potential of PASI 100 – complete elimination of psoriasis skin symptoms – that keeps scientists constantly motivated to look for new angles and always ask “what’s next?”

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The Next Frontier: Stopping the Disease Before it Starts

While many researchers are on the quest to help psoriasis patients achieve completely clear skin, others imagine crossing a more ambitious frontier: disease interception.

“In the future, we would like to be able to intervene very quickly and even completely prevent psoriasis. Our goal is disease prevention and eventually cure,” Honczarenko says.

“To get there, we will need to change the approach of the whole field. We will need more work in diagnostics and the ability to predict a patient’s response to available therapies. If we are successful one day, it could be tremendous for patients and a demonstration of the power of personalized medicine.”

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Florian Dieckmann
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