Are We Going to Discover a Cure in This Decade?
from William F.

I have P and two of my 3 kids have P.  I have tried to stay on top of the new drugs and research. In the 90s we had high hopes for gene research. Am I correct in saying we found too many "involved genes" for a "cure" to be easily figured out? In this century, so far, biologics have been all the rage, but they have never claimed to be a cure and they seem to me to be just another expensive way to control the symptoms. 

I lived through the 90s and the first decade of the 21st Century thinking a cure was just around the corner. I shared my optimism with my 2 P-kids. What should I tell them, now?  -Bill F.

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Ed's Response: I know your question is rhetorical, William. Anyone who really knows how far we are from a cure for psoriasis isn't talking. Those who have "good feelings" about an approximate length of time to a cure are largely silent because they're tired of looking foolish. Any guess would make a poor bet in my estimation.

Last spring I posed a variant of your question to Bruce Bebo, head of Research at the National Psoriasis Foundation. Here's that exchange:

DEWKE: As an immunologist yourself, do you think the "cure" for psoriasis, when and if one is found, will likely be closely related to curing other immune system diseases (e.g., Crohns)?

BEBO: The quick answer to your question is yes. But let’s not stop there; I also have a long answer. First, I think a cure for psoriasis is within our grasp and that it is just a matter of time. The reason for this optimism is that the pace of our understanding of this disease is accelerating tremendously. I think one has only to look at the growing number of new effective treatments that have been approved for psoriasis in the past few years as evidence. As we gain more knowledge, particularly of the immune system, more and better treatments will become available and ultimately a treatment will come that will result in a permanent suppression of psoriasis. The fact that psoriasis is generally not a degenerative disease means that once we conquer the immune system we will have a cure. This is in contrast to other autoimmune diseases like multiple sclerosis or rheumatoid arthritis where tissues (central nervous system and joints, respectively) are damaged and must be repaired before one can claim a cure.

Psoriasis likely shares common elements with Crohn’s disease and for that matter with other autoimmune diseases. An increased understanding for psoriasis certainly helps accelerate the understanding and treatment of other autoimmune diseases like Crohn’s. Because the organ effected by psoriasis (the skin) is easily accessible, one could argue that research in psoriasis might provide more clues than studying autoimmune diseases where the site of action is not as accessible — MS–the brain, RA–the joint, Crohn’s–the GI tract.

Bebo's assertion that "ultimately a treatment will come that will result in a permanent suppression of psoriasis" is appropriately optimistic but it gives one the feeling that if you just keep building the tower taller and taller, one day you'll reach heaven. I'm not sure the progression of new drugs for the treatment of psoriasis is moving in the right direction to achieve an ultimate "cure." The biologics, so far, use proteins to modify other protein responses that contribute to the formation of plaques and/or other types of psoriatic inflammation. The biologics DON'T turn off the chain of events that result in psoriasis, they merely interrupt it for awhile. This is why psoriatics who use biologics anticipate long-term use. (It's the same with type 1 diabetics and their insulin.) Administration frequency is improving. One of the latest biologics approved for psoriasis, Stelara, is administered once every 12 weeks after two start-up doses 4 weeks apart. If Stelara works well and widely, I imagine a lot of its users will consider themselves "cured."

Expanding your rhetorical inquiry just a bit, we could ask, "What improvements in treatment efficacy and availability do we have to look forward to in this decade?" If Stelara works well, it enters this new decade having set the bar quite high for any "better" drugs or treatments. A shot every three months? That's hardly a treatment at all. What could be better? A shot only when you need it? What if a shot eliminates your psoriasis symptoms for years instead of months? That sounds like the next best thing to a cure, doesn't it? Perhaps that's what Dr. Bebo was anticipating. We can only hope! The high cost of all these biologic drugs is another matter. Will we see its availability improve under some form of healthcare reform? I just don't know.  -Ed

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