Costly New Options In Psoriasis Care

The new biologically engineered treatments promise more targeted therapy without those risks:
Amevive and Raptiva interfere with the harmful T cells, dramatically clearing psoriasis lesions in 20 percent to 40 percent of patients.
Amevive causes those T cells to die, explaining why some people’s symptoms don’t return for months after a three-month course of weekly shots. About 3,500 patients have begun Amevive since FDA approval in January, says maker Biogen Inc. The intramuscular shots are given in a doctor’s office.
In contrast, Raptiva keeps harmful immune cells from getting into and inflaming skin, so patients must take it indefinitely. Sales will begin by Thanksgiving, say makers Genentech Inc. and Xoma Ltd. Patients give themselves weekly under-the-skin shots.
That difference means more than convenience; some insurance pays for in-office therapy but not at-home drugs.
Instead of targeting T cells, Enbrel and Remicade inhibit a protein, TNF, that’s crucial to inflammation. FDA-approved for certain types of arthritis, some doctors already use the drugs for psoriasis’ skin lesions. The FDA now is evaluating Enbrel injections for that use; a final-stage study of intravenous Remicade is about to begin.
Specialists call the four new treatments largely safe but acknowledge that even mildly tinkering with the immune system for years might spur infections or cancer. “We’re crossing our fingers,” Tharp says.
That plus their huge cost means the new drugs are reserved for the worst patients. For less severe psoriasis sufferers, “we’re back in the stone ages,” Tharp says, urging companies to study better options for them, too.
The new options don’t help everyone, cautions Dr. Michael Tharp, dermatology chief at Chicago’s Rush University Medical Center. And they’re very expensive, costing $10,000 a year or more.