5 Emerging Treatments for Psoriasis in 2023

Recent breakthroughs in psoriasis treatment are offering new hope for patients with this chronic skin condition. Here's what dermatologists need to know.

Introduction

Psoriasis affects approximately 125 million people worldwide, causing physical discomfort and often significant psychological distress. While traditional treatments have provided relief for many patients, a substantial number continue to struggle with inadequate symptom control and treatment side effects.

The good news is that our understanding of psoriasis pathophysiology has expanded dramatically in recent years, leading to the development of novel therapeutic approaches. This article highlights five of the most promising emerging treatments that dermatologists should be aware of in 2023.

1. Next-Generation Biologics

The success of biologics targeting TNF-α, IL-17, and IL-23 has revolutionized psoriasis treatment over the past decade. Now, a new wave of biologics is entering clinical trials with even greater specificity and efficacy.

TYK2 Inhibitors

Tyrosine kinase 2 (TYK2) inhibitors represent an exciting new class of oral medications for psoriasis. Unlike JAK inhibitors, TYK2 inhibitors offer more selective targeting of inflammatory pathways, potentially reducing side effects while maintaining efficacy.

Deucravacitinib (Bristol Myers Squibb) has shown particularly promising results:

• 75% of patients achieved PASI-75 at week 16 in Phase 3 trials
• Superior efficacy to apremilast with a similar safety profile
• Minimal laboratory abnormalities compared to JAK inhibitors
• FDA approval expected by late 2023

"TYK2 inhibitors may offer the efficacy of biologics with the convenience of oral administration, potentially changing our treatment paradigm for moderate-to-severe psoriasis." - Dr. Emma Richardson, Director of Clinical Research at Dermatology Partners

Dual IL-17A/F Inhibitors

Current IL-17 inhibitors target either IL-17A alone or the IL-17 receptor. New dual inhibitors targeting both IL-17A and IL-17F may provide enhanced efficacy:

• Bimekizumab has demonstrated superior skin clearance rates compared to secukinumab and adalimumab in head-to-head trials
• Up to 85% of patients achieve complete skin clearance (PASI-100) by week 16
• Longer duration of response between maintenance doses

2. Topical JAK Inhibitors

While systemic JAK inhibitors have raised safety concerns, topical formulations may offer localized benefits with minimal systemic absorption. Topical delgocitinib and ruxolitinib are showing promise for mild-to-moderate psoriasis:

• Effective for difficult-to-treat areas like face, genitals, and intertriginous zones
• Rapid itch relief within 24-48 hours
• Minimal systemic absorption
• Complementary to existing topical treatments

Clinical trials show these agents may be particularly valuable for patients with limited disease who prefer to avoid systemic therapy or phototherapy.

3. IL-36 Inhibitors for Pustular Psoriasis

Generalized pustular psoriasis (GPP) is a rare but potentially life-threatening form of psoriasis with limited treatment options. Recent genetic discoveries have identified IL-36 signaling as a key driver of GPP, leading to targeted therapies:

Spesolimab (Boehringer Ingelheim):

• First FDA-approved treatment specifically for GPP flares
• 54% of patients showed complete pustule clearance within one week
• Significant improvement in quality of life measures
• Being studied for maintenance therapy to prevent flares

This breakthrough provides the first targeted therapy for a previously undertreated form of psoriasis, with potential applications in palmoplantar pustulosis as well.

4. Oral Integrin Inhibitors

Integrins are cell surface receptors that play a crucial role in immune cell trafficking and activation. Oral integrin inhibitors represent a novel approach to psoriasis treatment:

VTX002 (Ventyx Biosciences):

• Selectively blocks α4β7 integrin, reducing T-cell migration to inflamed tissues
• Phase 2 trials show 62% of patients achieving PASI-75 at week 12
• Once-daily oral dosing
• No cases of progressive multifocal leukoencephalopathy (PML) observed to date

These agents may offer a new oral option for patients who prefer not to use injectable biologics but require systemic therapy.

5. Microbiome-Based Therapies

Emerging research suggests the skin microbiome plays a significant role in psoriasis pathogenesis. Several approaches to microbiome modification are under investigation:

• Topical live biotherapeutic products containing beneficial bacteria strains
• Prebiotic formulations that promote growth of commensal organisms
• Postbiotic metabolites that modulate immune response

Early clinical trials show these approaches may help restore microbial diversity and reduce inflammation, particularly when combined with conventional treatments.

SB414 (Novan Therapeutics), a nitric oxide-releasing cream that modulates the skin microbiome, has shown a 30% reduction in psoriasis severity after 4 weeks of treatment in Phase 2 studies.

Implementation Considerations

When considering these emerging therapies, dermatologists should keep several factors in mind:

Patient Selection

• Comorbidities: Consider cardiovascular, metabolic, and psychiatric comorbidities when selecting treatments
• Treatment history: Prior treatment failures may guide selection of agents with novel mechanisms
• Patient preferences: Weigh oral vs. injectable options, monitoring requirements, and cost considerations

Combination Approaches

Many of these emerging therapies may be most effective when used in strategic combinations:

• Sequential therapy (e.g., biologic induction followed by oral maintenance)
• Combination with phototherapy for enhanced efficacy
• Adjunctive topical therapy for resistant areas

Cost and Access

Novel therapies often come with significant cost concerns. Strategies to improve patient access include:

• Familiarity with patient assistance programs
• Advocating for coverage with insurers
• Considering biosimilars when available

Conclusion

The psoriasis treatment landscape continues to evolve rapidly, offering new hope for patients with this challenging condition. By staying informed about emerging therapies, dermatologists can provide optimal care while managing patient expectations about new treatment options.

These five approaches—next-generation biologics, topical JAK inhibitors, IL-36 inhibitors, oral integrin inhibitors, and microbiome-based therapies—represent the cutting edge of psoriasis treatment in 2023. As these therapies move through clinical development and into practice, they promise to expand our therapeutic armamentarium and improve outcomes for patients with psoriasis.

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This article is based on clinical trial data available as of June 2023. Treatment availability and guidelines may change as additional data emerges and regulatory decisions are made.