Research into the pathophysiology and treatment of psoriasis has advanced substantially. Attendees at Skin Disease Education Foundation’s 12th Annual Psoriasis Forum were provided with current insights into the inflammatory underpinnings of psoriasis and the efforts to apply that knowledge to the development of new treatment. The faculty included some of the leading investigators in this field.
Within the last 10 years or so, research has elucidated the role of T helper 17 (Th17) cells in psoriasis inflammation. The first article in this supplement lays a foundation for the others by describing these findings and the role of the Th17 cytokine pathway in perpetuating this disease.
The next article focuses on two nonbiologic, oral therapies: the retinoid acitretin and the Janus kinase inhibitor tofacitinib. The first is an older agent that offers efficacy for certain patient types. The second is approved by the US Food and Drug Administration (FDA) for use in rheumatoid arthritis but not for psoriasis.
The introduction of the tumor necrosis factor (TNF)-α inhibitors for treatment of psoriasis revolutionized the care of this disease. The anti-TNF agents remain the cornerstone of therapy for psoriasis. More than a decade of experience using the TNF-α inhibitors in clinical practice has yielded a large body of data regarding their safety and efficacy. Our faculty reviews these findings.
Two subsequent articles focus on newly introduced and investigational medications. Secukinumab, an interleukin (IL)-17A antagonist, received FDA approval last year for psoriasis therapy, and ixekizumab, just this year. Another sharing this mechanism—brodalumab—is under review at the FDA. Ustekinumab, an agent approved for psoriasis, targets both IL-12 and IL-23. Applications for marketing approval of another IL-12/23 inhibitor, briakinumab, were withdrawn due to safety issues. Our faculty reviews the safety and efficacy data for both of the agents. Three medications selectively targeting IL-23 show promise in early phases of development—guselkumab, tildrakizumab, and BI 655066—and published findings on these medications are reviewed.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Rutgers, The State University of New Jersey and Global Academy for Medical Education. Rutgers, The State University of New Jersey is accredited by the ACCME to provide continuing medical education for physicians.
Rutgers, The State University of New Jersey designates this enduring material for a maximum of 2.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Rutgers, Rutgers, The State University of New Jersey, Center for Continuing and Outreach Education (CCOE) is an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Number P173-5/31/16.
This activity is awarded 3.16 contact hours. (60 minute CH)
Nurses should only claim those contact hours actually spent participating in the activity.
Method of Participation
Participants should read the CE information below, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.
Basic research into the pathophysiology of psoriasis has identified new potential therapeutic immunologic targets. Clinical development of therapies directed to these cytokines has proceeded rapidly. The National Psoriasis Foundation lists 12 injectable and 13 oral agents in various phases of clinical study for psoriasis. Additional findings have been published about safety and efficacy of the many medications available to treat psoriasis. The pace and volume of clinical research and drug development challenges physicians, physician assistants, nurse practitioners, nurses, and others managing psoriasis to treat patients based on the most updated findings. Safety issues as well as comparative efficacy and patient–specific factors are among the important considerations when choosing therapy. This educational activity updates the busy clinician about the latest pathophysiologic findings, small–molecule agents for psoriasis, current data about the tumor necrosis factor (TNF)-α inhibitors, and third- generation therapies targeting cytokines other than TNF-α. It also discusses the observation that a certain proportion of patients who initially respond to a biologic therapy for psoriasis lose some degree of response, and how to reduce the risk of this problem.
By reading and studying this supplement, participants should be better able to:
- Describe current findings about the role of T helper 17 (Th17) cytokines and interleukin (IL)-23 in the pathophysiology of psoriasis, and list the approved treatments for psoriasis targeted to these cytokines.
- Demonstrate familiarity with the efficacy data and safety issues associated with the nonbiologic systemic agents acitretin, apremilast, and tofacitinib.
- Compare and contrast the efficacy and safety data for the tumor necrosis factor (TNF)-α inhibitors available in the United States with each other and with other therapies.
- Differentiate TNF-α and non–TNF-α biologic agents based on their mechanism of action, efficacy, safety, and clinical use.
- Apply understanding of the loss of response observed with biologics for psoriasis to the implementation of measures intended to reduce its frequency.
Individuals in a position to control the content of this educational activity are required to disclose: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.
Kenneth B. Gordon, MD
Grant/Research: AbbVie Inc., Amgen Inc., Celgene Corporation, Eli Lilly and Company, and Janssen Pharmaceuticals, Inc. Consultant: AbbVie, Amgen, Boehringer Ingelheim Pharmaceutical, Inc., Celgene, Dermira Inc., Eli Lilly, Janssen, Novartis Pharmaceuticals Corporation, and Pfizer Inc.
Francisco A. Kerdel, BSc, MBBS
Grant/Research: AbbVie, Amgen, AstraZeneca, Celgene, Galderma Laboratories, L.P., Janssen, Novartis, Pfizer, and Valeant Pharmaceuticals North America LLC. Consultant: Celgene. Speakers Bureau: AbbVie, Amgen, Celgene, Galderma, and Janssen.
Craig L. Leonardi, MD
Grant/Research: AbbVie, Actavis, Inc., Amgen, Celgene, Coherus Biosciences, Dermira, Eli Lilly, Galderma, Janssen, LEO Pharma Inc., Merck & Co., Inc., Novartis, Pfizer, Sandoz, Stiefel Laboratories, Inc., and Wyeth Pharmaceuticals, Inc. Consultant: AbbVie, Amgen. Boehringer Ingelheim, Dermira, Eli Lilly, Janssen, LEO, Pfizer, Sandoz, UCB, Inc., and Vitae Pharmaceuticals, Inc. Speakers Bureau: AbbVie, Celgene, and Novartis.
Bruce E. Strober, MD, PhD
Grant/Research: AbbVie, Amgen, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Sun Pharmaceutical Industries Ltd and XenoPort, Inc. Consultant: AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Forward Pharma, Janssen, LEO Pharma Inc., Maruho Co. Ltd., Medac Pharma, Inc., Novartis, Pfizer, Stiefel/GlaxoSmithKline, Sun Pharmaceuticals, and UCB. Speakers Bureau: AbbVie. Scientific Director: Psoriasis Registry, Corrona, LLC.
In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, CCOE has resolved all potential and real conflicts of interest through content review by a non-conflicted, qualified reviewer. This activity was peer-reviewed tor relevance, accuracy of content, and balance of presentation by: Jean Sines, RN, BSN, Nurse, Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Ms Sines has no relevant financial relationships to disclose.
Field Testers: This activity was pilot-tested for time required by: Physicians: Daniel Grabell, MD, Brian Lee, MD, and Vijay Vanchinathan, MD. Nurses: Geraldine Bocchieri, BSN, RN, Stacy Johnson, RN, and Carol Ruland, RN. The field testers have no relevant financial relationships to disclose.
Rutgers, The State University of New Jersey: Tristan Nelsen, MNM, CMP, and Elizabeth Ward, MSJ, have no relevant financial relationships to disclose.
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Shirley V. Jones, MBA; and Eileen McCaffrey, MS, have no relevant financial relationships to disclose.
Off-Label/Investigational Use Disclosure
This activity discusses the following investigational products, not yet approved: brodalumab, guselkumab, tildrakizumab, and BI 655066. Also discussed is the investigational use of the approved agent, tofacitinib, in clinical trials of patients with psoriasis.
Contact Information for Technical Questions
Please technical questions or concerns to Global Academy for Medical Education at 973-290-8225 or email [email protected].
This continuing medical education (CME/CE) supplement was developed from faculty presentations at the Skin Disease Education Foundation’s 12th Annual Psoriasis Forum, held November 6, 2015, In Las Vegas, NV. The Guest Editors/Faculty acknowledge the editorial assistance of Global Academy for Medical Education, LLC, and Ellen McCaffrey, MS, medical writer, in the development of this supplement. The manuscript was reviewed and approved by the Guest Editors/Faculty as well as the Editors of Seminars in Cutaneous Medicine and Surgery for publication as a supplement to the journal. This activity was developed under the direction of the Faculty/Guest Editors, Global Academy for Medical Education, and Rutgers. The ideas and opinions expressed in this supplement are those of the Guest Editors and do not necessarily reflect the views of the supporters, Global Academy for Medical Education, Rutgers, or the Publisher.
Copyright © 2016 by Global Academy for Medical Education, LLC and Rutgers, The State University of New Jersey. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of Global Academy for Medical Education and Rutgers. Global Academy for Medical Education and Rutgers will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein.
Publication of this CME/CE article was jointly provided by Rutgers, The State University of New Jersey and Global Academy for Medical Education, LLC with Skin Disease Education Foundation (SDEF) and is supported by educational grants from AbbVie Inc. and Novartis Pharmaceuticals Corporation.
Dr Kerdel has received an honorarium for his participation in this activity. He acknowledges the editorial assistance of Eileen McCaffrey, MS, medical writer, and Global Academy for Medical Education in the development of this continuing medical education journal article.
Francisco A. Kerdel, BSc, MBBS, Grant/Research: AbbVie Inc, Amgen Inc, AstraZeneca, Celgene Corporation, Galderma Laboratories, L.P., Janssen Pharmaceuticals, Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc, and Valeant Pharmaceuticals North America, LLC. Consultant: Celgene. Speakers Bureau: AbbVie, Amgen, Celgene, Galderma, and Janssen.
Address reprint requests to: Francisco A. Kerdel, BSc, MBBS, Florida Academic Dermatology Centers, 1400 NW 12 Avenue, Suite 4, Miami, FL 33136; [email protected]