Newer, more expensive psoriasis drugs only slightly more effective than older therapies under real world conditions

More expensive biologic treatments for psoriasis were only marginally more effective than standard treatments, according to a new study led by researchers in the Perelman School of Medicine at the University of Pennsylvania. Researchers found that previously reported response rates from randomized controlled trials were higher than results in a clinical, real-world setting. The research was published in the Archives of Dermatology, one of the JAMA/Archives Journals.

The researchers found that biologics were slightly more effective than a standard drug treatment for psoriasis, methotrexate, but that their impact was less then what has been reported in clinical trials which study efficacy of a medication under idealized circumstances and only for a short period of treatment.

"When one looks at the outcome as being clear, or almost clear [skin], the biologics appear to be more effective than methotrexate," said study author Joel Gelfand, MD, assistant professor of Dermatology and Epidemiology. But, when total body surface area affected by the disease is added in that difference diminishes, he said. More importantly, patients noted no differences in health related quality of life with the newer biologic medications compared to methotrexate which has been used for psoriasis for over 40 years.

Gelfand noted that while the newer biologics are generally tolerated better by patients, with fewer side effects that lead to stopping the medication, their effectiveness diminishes with time. Traditional treatments may cause nausea and other potential side effects. Since psoriasis is a life-long disease, patients on biologics are often left with only a relatively short period of optimum control of their psoriasis.

Biologics can cost $10,000 to $20,000 a year, compared to a couple of thousand dollars for older drugs or phototherapy, said Gelfand.