Damal Kandadai Sriram

Utility of apremilast in the treatment of psoriasis

Psoriasis is an autoimmune multi-system disease with predominantly skin and joint manifestations affecting 2% percent of the world population. Psoriasis is not uncommonly associated with inflammatory bowel disease and part of the metabolic syndrome such as diabetes and cardiovascular disease. About 30% of these patients develops psoriatic arthritis, an inflammatory spondyloarthropathy. Psoriatic arthritis medication decreases pain, swelling and may help improve flexibility in the affected joints. Plaque psoriasis drugs reduces thickness, redness, scaling of the skin. In about 2-3% of patients, psoriasis is genetically inherited. The pathogenesis of psoriasis is a result of immune dysregulation. Understanding the part of immune system function in psoriasis and the interaction between the components of the immune system (innate, adaptive) has helped to manage this intricate disease. The common therapies used for psoriasis include most frequently used topical corticosteroids coal tar, keratolytic agents, Vitamin D analogs, topical retinoids, anti-metabolites, immunomodulators and biologics. Patients who fail to improve with topical therapy invariably require either photo-therapy or systemic therapy.

Tofacitinib- A First-In-Class Drug for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, systemic and disabling autoimmune inflammatory disease characterized by inflammation of the synovial lining of the joints, tendons and periarticular structure affecting approximately 1% of the population world-wide. Tofacitinib is a novel oral Janus-kinase inhibitor approved for the treatment of RA patients as a second line therapy in those who fail to respond to methotrexate therapy. Clinical trials with tofacitinib have shown reasonable efficacy. However, the drug’s greatest limitation is its potential to induce cancers and latent infections could be reactivated. Nevertheless, the drug can slow the progression of the disease and has evoked lot of interest due to the fact that it is a first in class molecule for the treatment of rheumatoid arthritis.

Mepolizumab in Eosinophilic Asthma–Striking a Target that was almost Debunked

Bronchial asthma continues to be a disease that has high morbidity and a significant proportion of patients remain symptomatic with frequent exacerbations, particularly the eosinophilic variant asthma. Mepolizumab is an anti-interleukin-5 humanized monoclonal antibody that prevents the eosinophilic inflammation in the lungs. The drug was found to reduce the sputum and blood eosinophilic count which was in consonance with its mechanism of action. However earlier clinical trials with the drug proved to be disappointing, due to the lacklustre performance with end points that focussed on the symptoms of the disease and pulmonary function testing. Subsequently trials focussed on selecting patients who had eosinophilic variant asthma with frequent exacerbations who were resistant to even treatment with systemic corticosteroids. The drug was shown to reduce the frequency of exacerbations in pivotal clinical trials besides reducing the dose of steroid requirement. Mepolizumab is to be given via subcutaneous injection once monthly at a dose of 75 to 250 mg. While the drug does meet an unmet need in the population, the long terms effects, most appropriate dose and frequency of usage and its efficacy in other related hypereosinophilic disorders warrants further exploration.