New targeted drugs may be safer than conventional treatments to treat the skin condition psoriasis, a
However, researchers note these biologic drugs are more expensive to use.
That fact may cause consumers to wonder whether the benefits of them are worth the cost.
These biologics work by inhibiting an overactive immune response that causes the disease’s symptoms.
The drugs are effective in clearing skin rashes and other conditions caused by psoriasis.
In this study, researchers compared the risk of serious infection, a potential side effect due to the immune-altering effects of the new drugs, against seven other medications.
“There is a good amount of data published on the comparative effectiveness of systemic treatments for moderate to severe psoriasis but very little on comparative safety,” Dr. Erica D. Dommasch, MPH, the study’s lead author and a dermatologist in the department of dermatology at Beth Israel Deaconess Medical Center in Massachusetts, told Healthline.
Dommasch has previously consulted with some pharmaceutical companies and also received grants from them.
The research team used data from two insurance claims databases that included more than 250 million people in the United States.
They tracked the incidence of serious infection requiring hospitalization in 107,000 people with psoriasis who had a prescription claim for one of seven systemic (affecting the whole body) drugs approved to treat moderate to severe psoriasis.
The drugs included acitretin and methotrexate. The researchers also looked at the biologic drugs adalimumab, etanercept, ustekinumab, and apremilast.
“One of the side effects that patients and physicians are the most concerned about with these medications is a potential increased risk of infection,” Dommasch said.
She says the study was limited so far as they were unable to identify many users of infliximab, which is given as an intravenous medication.
“Therefore it’s often not coded in databases as a prescription fill, which is how we identified users of the systemic medications,” she noted. “We also weren’t able to look at baseline psoriasis severity across the different medications, which also may impact the risk of infection.”
Biologics work by inhibiting the effects of different types of cytokines (immune system proteins) that are an important factor in psoriasis.
Dommasch and her team found those using biologics had a significantly lower risk for infection compared to those taking the other drugs.
The newer drugs were also shown to be more effective at clearing symptoms and likely safer since they specifically treat the overactive immune response that causes psoriasis rather than suppressing the whole body’s immune system.
Dr. Richard Torbeck, a board-certified dermatologist with Advanced Dermatology PC, who wasn’t associated with this study, said, “The newer biologics are more targeted compared to the older therapies. This allows them to be more effective, sometimes reaching total skin clearance with fewer side effects. We’re less worried about immunosuppression in the patient and immunosuppression-related cancer risk.”
Torbeck notes that the risk of developing psoriasis has a lot to do with family history.
“But no ‘smoking gun’ has yet been found as a cause,” he said.
Torbeck explains that psoriasis may also cause pain in the joints, usually in the hands, knees, and feet, that’s experienced as stiffness that improves with movement.
“I’ll usually start them on a topical steroid with and without topical vitamin D,” he said. “If it’s moderate to severe with or without arthritis, I’ll discuss biologics, phototherapy/lasers, and systemic therapies. I take all this and the patient’s desires into consideration.
“For topical steroids, there is a great therapeutic window, but there are side effects like thinning of the skin, steroid withdrawal symptoms such as skin worsening when not using treatment, and you can get acne,” he said.
This is where biologics have a distinct advantage.
According to Torbeck, these newer drugs have fewer side effects that make them, at times, a better choice and easier sell to the patient.
“Some of these new biologics don’t require the same level of lab monitoring, purport fewer lost days of work, no need for infusions, and provide almost totally clear skin,” said Torbeck.
“A counterpoint to look at is if there’ll be fewer hospital visits, quality of life issues, testing, and other disease-related factors with these newer medications,” he added.
Biologic drugs do come with a price.
“Typical treatments with biologics are quite costly, ranging anywhere from $10,000 to $25,000 per year. Other therapies for psoriasis are much less costly,” Dr. Suzanne Friedler, clinical instructor of dermatology at Mount Sinai Medical Center in New York and a board-certified dermatologist with Advanced Dermatology PC, told Healthline.
“The least expensive topical steroids may run in the hundreds for a year supply,” she added. “Phototherapy could cost about $5,000 for a year of therapy, and oral systemic agents could be in the low thousands.”
A 2018 study concluded that the expense of biologic drugs is probably because patent protections are preventing many alternative drugs, called biosimilars (cheaper copies of biologics), from competing in the U.S. market.
“There is a need for further cost-effectiveness studies to determine whether the potentially superior safety profile and efficacy of some of these medications can justify the increased costs,” said Dommasch. “That said, the type of information we have presented in this study is important for this.”
“Often a determining factor in what psoriasis treatment is chosen is what’s covered by a patient’s insurance,” Friedler added.
“As with any new medication, the initial period sees high cost because manufacturers are trying to recoup their [research and development] investment,” Torbeck explained. “The new biologics are cost prohibitive in the early going, but there are programs from the drug companies to provide access to these potentially life-changing medicines.”
Dommasch says affordability might improve if biologics prove their cost-effectiveness, “potentially leading to a more evidence-based approach to what insurers are willing to cover.”
“However, at the present moment, patients and providers generally have their choice of medications restricted by what their plans will cover,” she said.
A new study finds a class of drugs called biologics are safer than conventional treatments for psoriasis.
These drugs are in many instances also more effective at clearing up disease symptoms.
However, these new drugs are also expensive and not always covered by insurance. Experts believe the price could decrease in the years ahead.