question: Why are there so many different medications on the market right now for "moderate-to-severe plaque psoriasis"?
comment: Because that’s not all that it treats. A LOT of these drugs treat basically what are side effects of an overactive immune system. Rheumatoid arthritis, plaque psoriasis, Crohn’s disease ulcerative Colitis, Ankylosing Spondylitis Etc. most are injections, so the few that are coming out are tablets or capsules because some of these people are unable to administer their own injections. A big problem is that they usually require further review and most insurance companies will not cover some of these meds
passages: Guidelines regard biologics as third-line treatment for plaque psoriasis following inadequate response to topical treatment, phototherapy, and non-biologic systemic treatments. The safety of biologics during pregnancy has not been assessed. European guidelines recommend avoiding biologics if a pregnancy is planned; anti-TNF therapies such as infliximab are not recommended for use in chronic carriers of the hepatitis B virus or individuals infected with HIV.
   The treatments used for plaque psoriasis can also be used for guttate psoriasis. Few studies have specifically focused on guttate psoriasis management, so there is currently no firm guidelines for managing guttate psoriasis differently from plaque psoriasis. Due to the role streptococcal infection plays in the development of guttate psoriasis, systemic antibiotics have been considered as a potential treatment option. Although systemic antibiotics may be considered to treat the initial infection at its source, there is no support for their use in the management of subsequent guttate psoriasis itself, nor is there evidence for the use of prophylactic tonsillectomy. The condition often usually clears up on its own within weeks to months, and only about one third of patients will develop chronic plaques.
   Alefacept is indicated for the management of patients with moderate to severe chronic plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy. The concomitant use of low-potency topical corticosteroids was permitted during the treatment phase with alefacept and does not seem to pose any additional risks.
   GSK2831781's first clinical trial is a Phase I in both psoriasis patients and healthy individuals. 
  
  The trial is expected to recruit around 63 subjects, half of whom will be healthy and half of whom will have plaque psoriasis. The healthy subjects will be given BCG in order to track DTH and subsequent response to antibody treatment. The study will be randomized, double blind, placebo-controlled, and single ascending dose. As well as evaluating safety and tolerability the study will investigate mechanisms of action and clinical endpoints. It is planned to complete by Feb 2018.
   Section::::Signs and symptoms.
  
  Section::::Signs and symptoms.:Plaque psoriasis.
   BULLET::::- Apremilast, a phthalimide derivative that was approved by the U.S. FDA in March 2014 for use as a treatment for psoriatic arthritis, and in September 2014 for the treatment of plaque psoriasis under the brand name Otezla.
  
  BULLET::::- Cilomilast, in clinical development by GlaxoSmithKline for treatment of COPD.
  
  BULLET::::- Crisaborole (AN2728), a boron-containing drug for the topical treatment of psoriasis and atopic dermatitis. It was approved by the FDA on December 14, 2016 under the brand name Eucrisa for the treatment of mild-to-moderate atopic dermatitis (eczema) in patients 2 years of age and older.
   Many novel medications being researched target the Th17/IL-23 axis, particularly IL-23p19 inhibitors, as IL-23p19 is present in increased concentrations in psoriasis skin lesions while contributing less to protection against opportunistic infections. Other cytokines such as IL-17 and IL-22 also have been targets for inhibition as they play important roles in the pathogenesis of psoriasis. Another avenue of research has focused on the use of vascular endothelial growth factor inhibitors to treat psoriasis. Oral agents being investigated as alternatives to medications administered by injection include Janus kinase inhibitors, protein kinase C inhibitors, mitogen-activated protein kinase inhibitors, and phosphodiesterase 4 inhibitors, all of which have proven effective in various phase 2 and 3 clinical trials. However, these agents have potentially severe side-effects due to their immunosuppressive mechanisms.
   Biologics are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalised immunosuppressive drug therapies such as methotrexate, biologics target specific aspects of the immune system contributing to psoriasis. These medications are generally well-tolerated and limited long-term outcome data have demonstrated biologics to be safe for long-term use in moderate to severe plaque psoriasis. However, due to their immunosuppressive actions, biologics have been associated with a small increase in the risk for infection.
   The drug was approved based upon studies involving 1,869 patients altogether with plaques covering at least 10% of body surface. Either 7.5 mg IV or 15 mg IM once a week were applied. The long-term results (reduction of at least 75% in pretreatment PASI scores) were 14% and 21%, respectively. Additional improvements ensuing after completion of the 12-week treatment phase or after completion of a second alefacept treatment were also seen. Often the remissions were maintained for 7 to 12 months after end of treatment.
  
  Section::::Contraindications and precautions.
   In an international, double-blind, parallel group study of 1603 patients with psoriasis (affecting at least 10% of one or more body regions), more patients on once-daily Cal/BD ointment had controlled disease, defined as having absence or very mild disease at 4 weeks (56.3%) compared with Cal 50 µg/g (22.3%). In addition, a retrospective analysis of data from six phase 3, double-blind studies found that more patients treated with Cal/BD ointment achieved PASI 75 than patients treated with individual components, regardless of baseline disease severity.
  
  BULLET::::- Foam
   Psoriasis has been associated with obesity and several other cardiovascular and metabolic disturbances. The incidence of diabetes is 27% higher in people affected by psoriasis than in those without the condition. Severe psoriasis may be even more strongly associated with the development of diabetes than mild psoriasis. Younger people with psoriasis may also be at increased risk for developing diabetes. Individuals with psoriasis or psoriatic arthritis have a slightly higher risk of heart disease and heart attacks when compared to the general population. Cardiovascular disease risk appeared to be correlated with the severity of psoriasis and its duration. There is no strong evidence to suggest that psoriasis is associated with an increased risk of death from cardiovascular events. Methotrexate may provide a degree of protection for the heart.
   Section::::Prognosis.:Other diseases.
   Anti-inflammatory treatment trials for existing Alzheimer's disease have typically shown little to no effect on halting or reversing the disease. Research and clinical trials continue. Two studies from 2012 and 2013 found regular use of aspirin for over ten years is associated with an increase in the risk of macular degeneration.
  
  Section::::Ice treatment.
   Several monoclonal antibodies target cytokines, the molecules that cells use to send inflammatory signals to each other. TNF-α is one of the main executor inflammatory cytokines. Four monoclonal antibodies (MAbs) (infliximab, adalimumab, golimumab, and certolizumab pegol) and one recombinant TNF-α decoy receptor, etanercept, have been developed to inhibit TNF-α signaling. Additional monoclonal antibodies, such as ixekizumab, have been developed against pro-inflammatory cytokines and inhibit the inflammatory pathway at a different point than the anti-TNF-α antibodies. IL-12 and IL-23 share a common domain, p40, which is the target of the recently FDA-approved ustekinumab. In 2017 the US FDA approved guselkumab for plaque psoriasis. There have been few studies of the efficacy of anti-TNF drugs for psoriasis in children. One randomized control study suggested that 12 weeks of etanercept treatment reduced the extent of psoriasis in children with no lasting adverse effects.
   Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin characterized by circumscribed, erythematous, dry, scaling plaques.
  
  BULLET::::- Annular pustular psoriasis
  
  BULLET::::- Drug-induced psoriasis
  
  BULLET::::- Exanthematic pustular psoriasis
  
  BULLET::::- Generalized pustular psoriasis (pustular psoriasis of von Zumbusch)
  
  BULLET::::- Guttate psoriasis (eruptive psoriasis)
  
  BULLET::::- Inverse psoriasis
  
  BULLET::::- Keratoderma blennorrhagica (keratoderma blennorrhagicum)
  
  BULLET::::- Localized pustular psoriasis
  
  BULLET::::- Napkin psoriasis
  
  BULLET::::- Psoriasis vulgaris (chronic stationary psoriasis, plaque-like psoriasis)
  
  BULLET::::- Psoriatic arthritis
  
  BULLET::::- Psoriatic erythroderma (erythrodermic psoriasis)
  
  BULLET::::- Seborrheic-like psoriasis (sebopsoriasis, seborrhiasis)
  
  Section::::Reactive neutrophilic.
   Several conditions are associated with psoriasis. These occur more frequently in older people. Nearly half of individuals with psoriasis over the age of 65 have at least three comorbidities (concurrent conditions), and two-thirds have at least two comorbidities.
  
  Section::::Prognosis.:Cardiovascular disease.
   On November 21, 2008, the European Medicines Agency’s (EMEA) Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion for ustekinumab for the treatment of moderate to severe plaque psoriasis in adult patients who failed to respond to other systemic therapies.
  
  Section::::Approvals.
  
  Since 2009, Ustekinumab is approved in Canada, Europe and the United States to treat moderate to severe plaque psoriasis. On September 24, 2013, the FDA approved the use of ustekinumab for the treatment of psoriatic arthritis.
   Section::::Management.:Systemic agents.
  
  Psoriasis resistant to topical treatment and phototherapy may be treated with systemic therapies including medications by mouth or injectable treatments. People undergoing systemic treatment must have regular blood and liver function tests to check for medication toxicities. Pregnancy must be avoided for most of these treatments. The majority of people experience a recurrence of psoriasis after systemic treatment is discontinued.
   Guselkumab was developed by Janssen Global Services, LLC. In November 2016, Janssen submitted a Biologics License Application (BLA) to the FDA seeking approval of guselkumab. In July 2017 Janssen gained US FDA approval to market guselkumab for treatment of plaque psoriasis. Usage for psoriatic arthritis has also been approved in Japan as of April 2018. Guselkumab is manufactured by Janssen Sciences Ireland UC in Cork, Ireland.
  
  Section::::Commercialization.:Cost.
  
  The list price of each 100 mg dose (to be given once every two months) is about $10,000.
  
  Section::::Commercialization.:Research and development.
  
  During development, guselkumab was referred to as CNTO-1959.
   BULLET::::- Improve the health of people with psoriatic disease by doubling the number of people who are receiving appropriate treatment; cutting in half the number of people who report that psoriatic disease is a problem in everyday life; and doubling the number of health care providers effectively managing patients with psoriasis and psoriatic arthritis.
  
  BULLET::::- Conduct the largest and most comprehensive realignment and expansion of its psoriatic arthritis program — including reducing the time of diagnosis from four years to one — since NPF began serving this patient population.
  
  Section::::Research.
   In September 2018, it was approved by the European Commission for the treatment of adult patients with moderate-to-severe chronic plaque psoriasis who are candidates for systemic therapy.
  
  Section::::See also.
  
  BULLET::::- Guselkumab, another experimental, IL-23-specific monoclonal antibody (FDA approved in 2017)
  
  BULLET::::- Risankizumab, another experimental, IL-23-specific monoclonal antibody (FDA approved in 2019)
  
  BULLET::::- Ustekinumab, a monoclonal antibody targeting both IL-12 and IL-23 and used to treat plaque psoriasis, launched in the United States under the brand name Stelara
   Section::::Treatments.:Disease-modifying antirheumatic drugs.
   In the context of melanoma, certain treatments, such as Ipilimumab, result in high grade adverse events, or immune-related adverse events, in 10-15% of patients that parallel the effects of metastatic melanoma itself. Similarly, several common adjuvant therapies are noted for having the potential of causing cardiovascular disease. In such cases, physicians must weigh the cost of future recurrence against more immediate consequences and consider factors, like age and relative cardiovascular health of a patient, before prescribing certain types of adjuvant therapy.
   Non-profit organizations the National Psoriasis Foundation in the United States, the Psoriasis Association in the United Kingdom and Psoriasis Australia offer advocacy and education about psoriasis in their respective countries.
  
  Section::::Society and culture.:Cost.
   BULLET::::- Changes in pigmentation
  
  BULLET::::- Skin atrophy
  
  Section::::Interactions.
  
  No drug interactions are known.
  
  Section::::Pharmacology.
  
  Section::::Pharmacology.:Mechanism of action.
  
  The efficacy of calcipotriol in the treatment of psoriasis was first noticed by the observation of patients receiving various forms of vitamin D in an osteoporosis study. Unexpectedly, some patients who also suffered from psoriasis experienced dramatic reductions in lesion counts.
  
raw_presuppositions: Plaque psoriasis medication is strictly for plaque psoriasis. Medications that treat moderate to severe plaque psoriasis only treat this obscure disease.
raw_corrections: Plaque psoriasis medication can be used to treat other diseases. Medications that treat moderate to severe plaque psoriasis can treat a variety of conditions.