Advancements in Psoriasis Therapies with Jason Hawkes, MD, MS

Jason Hawkes, MD, MS, an investigator at the Oregon Medical Research Center, discussed recent advancements in psoriasis treatments during a session at Elevate Derm West 2024 focused on how the therapeutic landscape has evolved. He highlighted significant progress in understanding the immunological pathways of psoriasis, particularly the IL-23 and IL-17 pathways. These discoveries have led to highly effective biologic therapies. However, the development of oral treatments has been slower, with many existing options being broad-acting immunosuppressants that come with significant adverse events, such as liver and kidney toxicity, or gastrointestinal issues.

Hawkes reviewed key milestones in oral therapy development. Apremilast, an early oral treatment, had limited efficacy in achieving full skin clearance and was associated with a high rate of gastrointestinal adverse events. The introduction of deucravacitinib, a selective TYK2 inhibitor, marked an important advancement. This once-daily oral pill offered better efficacy and fewer contraindications, with about 20% of patients achieving full skin clearance. However, it still falls short of the efficacy seen in biologics.

Looking ahead, Hawkes highlighted promising developments in oral therapies. Second-generation TYK2 inhibitors, now in clinical trials, demonstrate improved selectivity, efficacy, and tolerability compared to their predecessors. Additionally, oral IL-23 receptor inhibitors are showing great potential. These treatments mimic the safety and efficacy of biologics, with early trials indicating that nearly 40% of patients achieved complete skin clearance. These advancements are narrowing the gap between oral therapies and biologics, offering patients more effective options without sacrificing convenience or efficacy.

Hawkes also discussed recent innovations in biologics. Bimekizumab, a dual IL-17A and IL-17F inhibitor, is one of the most effective treatments available for plaque psoriasis and psoriatic arthritis. Additionally, spesolimab, an IL-36 receptor blocker, has been approved for generalized pustular psoriasis (GPP). It is available in both intravenous form for acute flares and subcutaneous form for maintenance therapy.

In conclusion, Hawkes emphasized the growing array of treatment options for psoriasis, particularly the exciting advancements in oral therapies that are closing the efficacy gap with biologics. These developments provide patients with more choices tailored to their treatment preferences, whether they prioritize the convenience of oral pills or the high efficacy of injections.