A ‘new’ drug for moderate-to-severe plaque psoriasis is now available in Malaysia.
OFTEN mistaken as a mere cosmetic nuisance, psoriasis has a considerable impact on both the mental and physical well-being of patients.
In most cases, psoriasis sufferers spend a lot of time hiding, literally, beneath clothing, and avoiding social situations due to discomfort and embarrassment.
It is a long-lasting, non-contagious, and often misunderstood disease. Many who endure this condition are unaware of what it is and how it is caused. Here’s a definition for clarification.
Dr Chow explaining how ustekinumab works at the recent launch of the drug in Malaysia.
Psoriasis is a common skin disease that affects the lifecycle of skin cells. It causes cells to build up rapidly on the surface of the skin, forming thick silvery scales, and itchy, dry red patches that are sometimes painful.
Normal skin cells mature and shed in an ongoing cycle of 28 to 30 days. In psoriasis, skin cells mature in just three or four days. When psoriasis is severe, it can grow over large areas of the body.
Generally, the severity of psoriasis can be evaluated by body coverage:
·Severe psoriasis – more than 10% of the body
·Moderate psoriasis – from 3% to 10%
·Mild psoriasis – less than 3%
The degree of severity can also be measured by a tool called The Psoriasis Area & Severity Index, also known as PASI. This tool is a measure of the average redness, thickness and scaliness of lesions weighted by the area of involvement.
“I have been working with patients who suffer from moderate-to-severe psoriasis for many years, and I’ve seen how the disease affects patients’ relationships and their sense of self-esteem. Psoriasis patients are also at increased risk for other diseases such as obesity, diabetes, hypertension and myocardial infarction,” said Dr Steven Chow Kim Weng, honorary medical adviser for the Psoriasis Association of Malaysia.
For those who believe psoriasis is genetically induced, you are not entirely wrong. As with many genetically influenced diseases, psoriasis tends to run in families.
Contrary to popular belief, hygiene is not a trigger for the onset of psoriasis. However, there are certain lifestyle factors that are often involved in the prevalence of psoriasis. These include heavy smoking, alcohol consumption, dietary preferences and excessive weight gain.
Managing psoriasis starts with accepting and acknowledging it as a chronic condition. Patients sometimes may not realise the severity of their condition and may mistake the issue as an allergic reaction, dry skin or a passing phase.
Especially for patients who suffer from moderate to severe plaque psoriasis, it is important to seek professional help from a doctor who can diagnose the condition and advise the most suitable treatment option to alleviate the condition.
Diagnosis is usually made after careful examination of the skin, followed by a biopsy. It is crucial for the patient to discuss treatment options with their doctor or dermatologist to determine which would be the optimal treatment for him/her.
Some of the treatment options include:
1. Topical treatment: creams, gels, lotions, sprays and shampoos.
2. Phototherapy: sunlight, UVB phototherapy, pulsed dye laser, combination light therapy.
3. Conventional systemic treatment: methotrexate, cyclosporine, hydroxyurea and retinoids pills.
It is important to remember that treatment options are personalised – they depend on the patients’ age, health, and also, the severity of the disease.
In moderate to severe psoriasis, the above options may not be as effective, and some patients may be contra-indicated or intolerated to these treatments. For such cases, the use of biologics is increasingly becoming a viable treatment option.
Biologics are derived from natural proteins found in living cells. Currently, all biologics used for the treatment of psoriasis must be injected. Biologics work by targeting the underlying cause of psoriasis – excessive skin cell growth due to an overactive immune system.
Pharmaceutical company Janssen, a division of Johnson & Johnson Sdn Bhd, recently launched ustekinumab – a prescription-based biologics drug to manage moderate-to-severe plaque psoriasis. It is the only biologics treatment for psoriasis available with a quarterly dosage (every 12 weeks), or as few as four injections per year, following two starter doses.
The drug has received approval in 57 countries for moderate to severe plaque psoriasis patients above 18 years of age. Administered by subcutaneous injection, ustekinumab is indicated to treat moderate to severe plaque psoriasis patients who have failed to respond to, or who have a contraindication to, or are intolerant to conventional systemic therapy.
According to two large phase 3 studies (PHOENIX 1 and PHOENIX 2), which involved a total of approximately 2,000 patients, at least two thirds of patients showed at least 75% clearer skin, as measured by PASI, at 12 weeks, after two injections of ustekinumab. Findings from these studies also showed that every 12-week dosing with the drug effectively maintains substantial skin clearance in most patients.
Ustekinumab is a prescription medicine that may affect activities of the immune system, and like all medicines, it can result in side effects, although not every patient will experience them. The most common side effects reported include upper respiratory tract infections and nasopharyngitis.
“Before receiving ustekinumab, it is imperative that patients visit their dermatologists for a thorough medical check-up. The medicine is not for everyone, and only a doctor can decide whether it’s right for an individual,” said Dr Chow.
> This educational article is contributed by Janssen. Janssen provides this information for educational and communication purposes only. It should not be construed as medical advice. Information in this article is not intended to replace, supplant or augment a consultation with a health professional regarding individual medical care.
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