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New drugs in dermatology

Wednesday, 19 February 2014

Every month I receive four or five medical journals and it is a struggle to keep on top of all the new material. Some journals are less relevant to my practice and they end up in the recycling after a quick scan but occasionally one comes across an interesting update. One such journal is that of the Royal College of Physicians and this month Aslam and Griffiths produced a summary of the new drugs in dermatology. If you were to ask any dermatologist about new drugs they would almost certainly talk of biologic therapies in psoriasis. These are specific proteins that target parts of the inflammatory pathway involved in disease. These are now common place in all dermatology departments for patients with moderate to severe psoriasis that have failed on standard therapies.

This wasn’t the thing that pricked my interest though. It was the fact that as well as the licensed drugs there are a whole future production line of new biologic therapies for psoriasis.  These have new targets that effect inflammatory mediators or their receptors such as Interleukin 17, which neutralises them stopping the inflammation that presents itself as disease. In addition to these large molecule treatments that require injection, new smaller molecules are in development that may be orally administered. This is all great news if you suffer with psoriasis but what about patients with other skin disease?

With the exception of a couple of drugs for advanced melanoma or very advanced basal cell carcinoma that can not be removed surgically, there is little comfort. Eczema effects many more people than psoriasis but new drugs are sadly lacking. Why is this? Understanding the immunology of a disease has allowed scientists to develop specific solutions to the problem and in a lot of other conditions our knowledge is not as great. Having a track record of managing conditions with these expensive drugs also promotes future development as it far more likely that they will gain approval from organisations like NICE, the national institute for health and clinical excellence. This allows the big pharmaceutical companies to keep developing new drugs in the same field. Lastly some of the original biologic drugs have been around for a while and soon will come to the end of their patent and this drives further development into new drugs that will be protected by a new patent.

Patients should be encouraged though by these new drugs and the new understanding of skin immunology they bring with them. I am sure other patients will benefit from these drugs too even if they were not designed for other diseases. I know there will be interest to see whether Interleukin 17 drugs or the Janus Kinase receptor inhibitors have effects on other autoimmune skin disease like alopecia areata.

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