New Options for Moderate & Severe Psoriasis
- Ryan Moslin, a medicinal chemist for Bristol Myers Squibb, helped invent a drug to that would help him manage his battle with psoriasis, something he was diagnosed with back in high school.
- After 12 years of research with Bristol Myers Squibb, a global biopharmaceutical company, Moslin and his colleagues created the FDA-approved drug SOTYKTU (deucravacitinib), an oral medication for people suffering from plaque psoriasis.
- SOTYKTU. or deucravacitinib, gained FDA-approved in September 2022. And thankfully, people with moderate to severe plaque psoriasis can find even more relief than ever before with oral medications.
- Deucravacitinib is a pill that blocks an enzyme called TYK2, which is responsible for the generation of certain cytokines that play a key role in the development of psoriasis, say experts. By blocking TYK2, they reduce those cytokines and psoriasis improves. It is remarkable in that it is a pill that has biologic type efficacy.”
After 12 years of research with Bristol Myers Squibb, a global biopharmaceutical company, the Canadian-born researcher and his colleagues created the FDA-approved drug SOTYKTU (deucravacitinib), an oral medication for people suffering from plaque psoriasis.Read More
Moslin was diagnosed with psoriasis as a high schooler in Grand Forks, British Columbia, after experiencing a few “plaques on his scalp”
“Soon he had flaky patches on his legs, elbows and back. He stopped wearing shorts, and a few years ago jeans became too uncomfortable to wear when the lesions became itchy,” the WSJ report says.
Moslin, who grew to love science as a child and chose to study chemistry in college, noted that the jeans would “catch on things” – causing them to “bleed.”
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He ultimately joined Bristol in 2010 as a senior research scientist after finishing up his postdoctoral research at the Massachusetts Institute of Technology.
By the time he joined the company, scientists were “trying to find a drug that could inhibit an enzyme called TYK2,” something Bristol thought could stop disease.
Since Bristol had discovered a “TYK2 blocker that binded to the enzyme” but were unsure whether it would work on disease, Moslin was given the assignment. Six months later, he built a “TYK2 blocker with the desired potency,” leading Bristol’s scientific leaders to bring more scientists in to do further reswarch.
“Moslin and his fellow scientists created and tested more than 6,000 molecules before synthesizing Sotyktu in 2013. They sent Sotyktu, known scientifically as deucravacitinib, out for testing to measure exposure. Moslin thought it would fail, so he built more molecules,” the WSJ report explains.
“About six weeks later, Moslin was in his office, a cramped space filled with papers, notebooks and sketches of molecules. He opened an email with the exposure results from tests in mice. They were positive.” By 2018 the drug was revealed to be safe on humans.
“You have hopes and daydreams almost in some ways,” Moslin said, referring to thinking whether the drug could be used on himself. “The road is so long, and there’s so many times that it can go wrong. I believed that it was possible. The science was so strong.”
About a month after the FDA approved SOTYKU in September 2022, Moslin was prescribed the drug, which prompted his lesions to string, stop flaring or itching, and become more manageable.
Moslin has since left working in the Bristol laboratory full-time, is now working with the company on SOTYKU clinical trials and physician use of the drug.
What to Know About SOTYKTU, A Drug For Plaque Psoriasis
The FDA approved the oral medication, called SOTYKTU or deucravacitinib, in September 2022. And the drug has proven to have little to no side effects compared to existing drugs on the market, which come with more potential side effects and “box warnings.”
Psoriasis is an autoimmune disease that results when the overactive immune system mistakenly attacks its own skin cells. It’s classified as a chronic inflammatory disease that drives inflammation throughout the body causing rapid skin cell growth which in turn leads to plaque and scale formation.
Dr. April Armstrong, Professor of Dermatology and Associate Dean for Clinical Research at Keck School of Medicine at the University of Southern California, previously told SurvivorNet, “It [Psoriasis] can occur anywhere on the body, including the scalp, elbows and knees.
“It can also affect intimate areas, such as the area under the breast, the skin folds and the genital areas. It really affects patients quality of life.”
What is Plaque Psoriasis?
Plaque psoriasis is the most common of all psoriasis types that make up around 80-90% of all cases. It’s characterized by thick and raised patches of skin known as plaques, dry white or silvery scales covering these plaques.
In the early stages, people may notice raised, red, and swollen areas that feel itchy and scratchy.
Understandably, psoriasis can be a highly uncomfortable and often embarrassing condition for those who develop it, and many people report that the emotional side effects can be the same, if not worse than the physical symptoms that they experience. Additionally, many people are not aware that psoriasis can affect your internal organs as well.
“Psoriasis is an inherited condition that affects the immune system, the skin, the joints, and other organs, including the heart. It is inherited by a combination of genes that you can get from both parents, and that, together with environmental factors, causes the cells of the skin to grow too quickly,” Dr. Mark G. Lebwohl, Dean of Clinical Therapeutics at the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai, told SurvivorNet in an earlier interview.
“Because it’s visible and apparent to the world, it’s associated with a lot of emotional stress. Depression is increased, suicidal thoughts are increased, and suicides increase, too.”
Thankfully, with the recently-FDA approved drug SOTYKTU (deucravacitinib), people with moderate to severe plaque psoriasis can find even more relief than ever before with oral medications.
The advantage of this new drug compared to others is its high efficacy without the side effects that can typically come along with other types of oral drugs for psoriasis.
“So deucravacitinib is a pill that blocks an enzyme called TYK2, which is responsible for the generation of certain cytokines that play a key role in the development of psoriasis,” Dr. Lebwohl explained to SurvivorNet.
“So by blocking TYK2, they reduce those cytokines and psoriasis improves. It is remarkable in that it is a pill that has biologic type efficacy.”
“There are two other pills that are quite effective, Cyclosporine (Gengraf, Neoral, SandIMMUNE) and Methotrexate (Trexall), but they have a lot of side effects and a lot of box warnings,” he continues. “Deucravacitinib has no box warnings, and very good efficacy – similar to biologics. Great efficacy without having to worry about side effects as much as you do with the other drugs.
Dr. Lebwohl, who is also chairman emeritus of the National Psoriasis Foundation medical board, says that the prescribed dose of this new medication is 6 milligrams a day.
“Since it comes from your genes, unless you change one of your parents, we’re just treating it, not curing it. And so you continue to take it. And even if your skin clears, and it may clear for a while, we are always thinking about, what is the psoriasis doing to your joints, what is the psoriasis doing to your heart, or other organs,” Dr. Lebwohl explained. “For those reasons, we often do try to continue patients on treatment.”
Deucravacitinib has been in clinical research for approximately five years. From beginning to end, that’s about the amount of time that it takes to get an approval for this type of drug. It is not supposed to used with other immunosuppressants.
Dr. Armstrong also weighed in on this drug option, telling SurvivorNet, “This is a significant breakthrough medication for our patients for a number of reasons. Number one, it has what we call the novel mechanism action. So it works differently from other medications that we have seen.
“And importantly, as an oral medication, it has very high efficacy, so it works quite well, and also it has a good safety profile.”
Because the drug fulfills all these different criteria that are important to patients in the short term and long term, such as the daily dosage, safety profile, and efficacy, Dr. Armstrong thinks “it will be quite revolutionary for our psoriasis patients to have this particular option.”
“Untreated plaque psoriasis can damage interior organs, not just the skin, not just psychological,” Dr. Lebwohl concludes. “Patients with bad psoriasis have an increase in heart attacks, increase in a form of arthritis called psoriatic arthritis, and it affects may other organs as well. So if patients have symptoms of psoriasis, they should not be ignored, they should be treated.”
What are the Different Types of Psoriasis?
There are several different types of psoriasis, with plaque psoriasis being the most common. The types differ in how they present and what they are caused by.
- Plaque psoriasis: This is the most common form of the disease (this is what Bridges has) and causes dry, raised skin patches that may be covered in scales. The patches may be itchy and tender.
- Nail psoriasis: This disease can affect fingernails and toenails and might cause nails to loosen from the nail bed.
- Guttate psoriasis: This disease typically affects young adults and children and is often caused by a bacterial infection, like strep throat.
- Inverse psoriasis: This type of psoriasis mainly affects skin folds, so it will often present in areas such as the groin, buttocks, or breasts, and can worsen with friction or sweating.
- Pustular psoriasis: This is an atypical (rare) form of psoriasis that causes pus-filled blisters to develop in widespread patches across the body.
- Erythrodermic psoriasis: This is also a rare form of the disease. It can cover the entire body with a red, peeling rash that may itch or burn intensely.
- Psoriatic arthritis: With this form of the disease, joints may become swollen, irritated, and painful. Sometimes, joint pain is the first or only symptom, while other times other symptoms like nail changes will occur for some people.
The treatment approach will depend on the type of psoriasis a person has, and what kind of symptoms they present with. Dr. Saakshi Khattri, a Dermatologist/Rheumatologist at Mount Sinai Health System, who previously spoke with SurvivorNet, notes that for some people, symptoms may resolve with over-the-counter (OTC) creams or ointments, while others with moderate to severe disease may need a more systemic approach.
“It is hard to generalize and say whether it will be progressive for everybody or whether this will just be like a lesion here and there, which sort of self resolves with some over-the-counter (OTC) or topical treatment options,” she says.
“The one thing that I would say as a Rheumatologist is that everybody should know that psoriasis is just not limited solely to the skin. You can have a joint involvement in about a third of patients. With psoriasis you can even go on to developing psoriatic arthritis.”
If a patient has developed rashes or scaly patches of skin and also begins noticing other symptoms, such as stiffness or joint pain, Dr. Khattri suggests seeking medical attention right away rather than trying to resolve the issue with mild over-the-counter (OTC) treatments.
“If you have psoriasis on the skin or what looks like psoriasis on the skin, along with the onset of joint pain or tenderness, whether it is sort of stiffness in the lower back or a swelling of the finger or a toe that is inexplicable, do think of psoriatic arthritis and then certainly reach out to healthcare providers sooner rather than later.”
Moving Forward: Questions to Ask Your Doctor
- Could my symptoms be related to another condition?
- What treatment options do I have?
- Are there any lifestyle adjustments I should make?
- How often should I be monitored?
- How does psoriasis usually progress? Can it come and go?
- How often can flare-ups occur?
Being Your Own Advocate
When it comes to your health, be a little pushy. You know your body better than anyone else. When you see a doctor for a problem, don’t hesitate to make sure that your question is fully answered and that you are comfortable with the plan moving forward.
From a doctor’s perspective, every problem should have a diagnosis, a treatment, a plan for follow-up, and a plan for what happens next if the treatment doesn’t work.
As a patient, if you don’t feel like each of these four things has been accomplished, just ask! Even if it requires multiple visits or seeing additional providers for a second opinion, always be your own advocate.
Contributing: SurvivorNet Staff