Dermatology Express Report

Based on data presented at the American Academy of Dermatology’s Academy ’05, July 20–24, 2005, Chicago, Illinois

Publication date: 2005-08-31

Incorporating TNF Inhibitors into the Dermatology Practice

This report was reviewed for medical and scientific accuracy by Robert A. Schwartz, MD, MPH, FACP, Professor and Head, Dermatology; Professor of Medicine, Pediatrics, Pathology and Preventive Medicine; University of Medicine & Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey.

Expert Commentary

Provided by Alan Menter, MD, Chairman of the Division of Dermatology, Baylor University Medical Center; Clinical Professor of Dermatology, University of Texas Southwestern Medical School, Dallas, Texas

Psoriasis has a devastating effect on quality of life and can produce significant morbidity, especially in the setting of psoriatic arthritis. Dermatologists are at the forefront of recognizing, diagnosing, and treating these conditions. In order to provide optimal care for their patients, dermatologists should be knowledgeable of the recent advances in the treatment of psoriatic skin and joint disease with all biologic agents, including tumor necrosis factor (TNF) inhibitors.

Psoriasis is a lifelong, genetic dermatological disorder characterized by epidermal hyperproliferation, increased dermal angiogenesis, and infiltration of mononuclear cells into the dermis and epidermis. Approximately 30% of patients with psoriasis will develop psoriatic arthritis,^1–3 a seronegative inflammatory arthritis associated with asymmetric oligoarthritis or polyarthritis potentially involving all peripheral joints.

Traditional treatment approaches for psoriasis and psoriatic arthritis are aimed at controlling symptomatic manifestations of the disease,^4–6 but do little to prevent the clinical progression of disease or structural joint damage.⁷ As psoriatic diseases may persist throughout a lifetime, there is a need for safe and convenient alternatives that can be maintained long-term. The newer treatment options, TNF inhibitors, control the inflammatory response that underlies psoriasis and psoriatic joint disease by inhibiting the pro-inflammatory cytokine TNF-α, which is present in excess amounts in both skin and joints. These agents represent a tremendous advancement in the treatment of psoriatic diseases. Evidence is accumulating that responses to TNF inhibitors can be maintained long-term. The favorable tolerability and safety profile of TNF inhibitors have been demonstrated in more than 600,000 patients over the past 12 years treated for rheumatoid arthritis and Crohn’s disease.

This Dermatology Express Report^TM reviews data on incorporating TNF inhibitors into the dermatology practice and the critical role of dermatologists in the management of psoriatic diseases as presented at a satellite symposium conducted during the American Academy of Dermatology’s Academy ’05 on July 23, 2005 in Chicago, Illinois.

Use of TNF Inhibitors in Psoriasis

Psoriasis affects approximately 2% of the general population,⁸ with a peak onset in young adulthood. Over a quarter of these patients will also develop psoriatic arthritis.^1–3 Psoriasis has a detrimental impact on quality of life and may lead to emotional suffering, frustration, and depression.

“Psoriasis can have devastating effects on these young people as they are struggling to make their way in the world,” according to Alan Menter, MD, Chairman of the Division of Dermatology, Baylor University Medical Center; Clinical Professor of Dermatology, University of Texas Southwestern Medical School, Dallas, Texas.⁹ In Dr. Menter’s opinion, the new biologic therapies should not be withheld until patients reach a severe state, and dermatologists should be committed to optimizing patient care by using the TNF inhibitors early in the disease process, especially if joint disease is established.

Three TNF inhibitors, infliximab, etanercept, and adalimumab, are currently being used for the treatment of psoriatic diseases. Etanercept and infliximab are approved for psoriatic arthritis; adalimumab is undergoing review for this indication and expected to be approv