Psoriasis - Anti-TNF's lead another indication

There is no cure for psoriasis, which profoundly affects sufferers quality of life, physical and social functioning. There is a particular unmet need for effective long-term therapies for psoriasis. Prevalence is the highest of the autoimmune diseases at 16 million in 2006, but this is deceptive in terms of market size, as the treated and severe patient populations are comparatively small.

The disappointment of initial biologics in psoriasis and the fact that a higher dose tends to be required from biologics to achieve efficacy can be off-putting to companies. However, Enbrel's success, with an estimated $933 m in sales in the seven major markets for psoriatic conditions in 2005, shows that this market is not to be neglected.

In a market driven by product switching, long term safety and efficacy is elusive. Year long trial data as exemplified by market leading biologics, is key and should be applied to all psoriasis products, be they biologic, traditional systemic or topical therapies.

Approval in psoriatic arthritis appears to add force to uptake in psoriasis but is not a key indication in itself. Novel therapeutics expanding from rheumatology indications should consider this strategy, but Enbrel has paved the way for anti-TNF therapies to launch directly in psoriasis.

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