Current challenges and emerging drug delivery strategies for the treatment of psoriasis

ABSTRACT

Introduction: Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction.

Areas covered: This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy.

Expert opinion: By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients’ psychosocial needs, treatment costs, convenience, and effectiveness with patients’ preferences in order to optimize treatment outcomes.

KEYWORDS:

• Treatment adherence
• biologics
• biosimilars
• small molecule agents
• compliance
• phototherapy
• systemics

Article highlights

• Patients’ psychosocial needs and treatment preferences must be recognized and addressed in order to achieve positive treatment outcomes.

• While topical therapy is a reasonable choice for patients with very localized psoriasis, its effectiveness is limited by poor patient adherence.

• The use of older oral agents is limited by toxicities while the use of newer biologic agents is limited by financial costs and inconvenience of administration.

• Emerging topical drug delivery strategies focus on using novel vehicles, including nanoparticles, or combination products, to safely and effectively deliver medications

• Novel oral medications targeting small molecules in pathogenetic pathway, including JAK and PDE-4, offer safe, effective treatment options over the conventional oral therapies.

• Emerging biologic therapy will focus on agents that target IL-17 an IL-23 and on the implementation of biosimilars into clinical practice.

This box summarizes key points contained in the article.

Declaration of interests

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. S Feldman is a speaker for Janssen and Taro. He is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Leo Pharma Inc. Dr. Feldman has received grants from Galderma, Janssen, Abbott Labs, Amgen, Stiefel/GlaxoSmithKline, Celgene and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc, Qurient, Suncare Research and Xenoport. He is on an advisory board for Pfizer Inc. S Feldman is the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives Royalties from UpToDate and Xlibris. D Hill’s translational research is funded by Janssen Pharmaceuticals LLC. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed