Health: 2.5 million Italians live with psoriasis and psoriatic arthritis

In Italy there are 2 and a half million people living with immune-mediated diseases such as psoriasis and psoriatic arthritis, about 20 million in Europe. These two conditions have a common link: an imbalance in the immune system that leads to chronic inflammation. Living with these diseases has an important impact on the quality of life: they are debilitating, chronic, they can cause pain with the inability to carry out daily activities and in many cases they are accompanied by comorbidities, including depression. An in-depth study was dedicated to these pathologies and the latest therapeutic innovations available to clinicians and patients during the media tutorial “Janssen Immunology: new frontiers in psoriasis and psoriatic arthritis”. Psoriasis (PsO) – remember – is a chronic relapsing skin disease that affects about 2 million people in Italy. It is caused by an immune-mediated inflammation and is characterized by erythematous-desquamative skin lesions that can occur in some limited areas or extend over the whole body. “There is no cure for psoriasis, but there are therapies by which it is possible to control the clinical manifestations of the disease, allowing long periods of remission. More than half of people with psoriasis also live with other diseases, such as diabetes, some heart diseases and depression “, explains Ketty Peris, full professor of Dermatology, director of Uoc Dermatology of the Agostino Gemelli Irccs University Polyclinic Foundation, Catholic University of Rome and president of the Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases (SIDeMaST). “Up to 30% of people with psoriasis can develop psoriatic arthritis over time. Although the cause of psoriatic arthritis is unknown, genetic predisposition, impaired immune systems, and certain environmental factors are believed to play a role in psoriatic arthritis. onset of the disease “, continues Peris. Psoriatic arthritis (PsA) is an immune-mediated chronic inflammatory disease that affects around 500,000 people in Italy. Causes pain, stiffness and swelling of the joints; it commonly occurs between the ages of 30 and 50 but can develop at any age. In patients with psoriatic arthritis, comorbidities such as obesity, cardiovascular disease, inflammatory bowel disease, anxiety and depression are often present. “Today, with the advent of therapies aimed at particular immunological targets, such as cytokines, it is possible to achieve clinical remission or alternatively, minimal disease activity. These two therapeutic objectives are of fundamental importance for patients, as they allow an improvement in the quality of life “, says Ennio Lubrano, full professor of rheumatology, University of Molise, Campobasso Developed by Janssen, guselkumab is the first fully human monoclonal antibody that selectively binds to the p19 subunit of IL-23 and inhibits its interaction with the receptor. IL-23 is an important pathogenetic factor of immune-mediated inflammatory diseases such as plaque psoriasis and active psoriatic arthritis. Guselkumab, by binding to the p19 subunit, which is specific to IL-23, blocks its effects, without affecting those of other inflammatory cytokines such as, for example, IL-12 and IL-17 which are, instead, important for the defense against the pathogens. This means that even when IL-23 is inhibited, immune responses can still take place. Guselkumab is approved as a prescription drug in the European Union, United States, Canada, Japan and several other countries for the treatment of adult patients with moderate to severe plaque psoriasis who are candidates for systemic therapy. In addition, guselkumab, alone or in combination with methotrexate, is approved in the European Union, the United States, Canada, Japan and numerous other countries around the world, for the treatment of active psoriatic arthritis in adult patients who have had a inadequate response or who have shown intolerance to previous disease-modifying antirheumatic drug therapy (Dmard). In Italy, guselkumab is currently reimbursed by the National Health Service in the indication of plaque psoriasis. “The discovery of IL-23, as a specific immunological mechanism of psoriasis and psoriatic arthritis, has allowed in recent years to develop very precise drugs against this target “, explains Carlo Francesco Selmi, head of the Rheumatology and Clinical Immunology Unit, Irccs Istituto Clinico Humanitas, Rozzano and professor of Humanitas University. “For this reason, the availability of a drug capable of selectively blocking IL-23, already used effectively by fellow dermatologists for the treatment of psoriasis – he underlines – will allow a treatment of the various manifestations of psoriatic arthritis with a safety profile that is now well established. The 2-year data recently presented at the American Society of Rheumatology congress confirm the stability of the response both on joint inflammation and that of other disease sites. Some studies also suggest that IL-23 blockade it could also improve asthenia and pain associated with psoriatic arthritis. In light of these data, the ‘Grappa’ and European recommendations place guselkumab at the forefront, like drugs that affect TNFalpha and IL-17, in the treatment of psoriatic arthritis candidate for biological therapy “, he adds.” The inhibition of IL-23 prevents the reactivation of the so-called memory T cells. exident, Trm cells, cells found in the skin of patients treated with any drug effective in psoriasis. Today, however, we know that the presence of a trigger factor and IL-23 generates the reactivation of Trm cells with consequent production and release of pro-inflammatory cytokines “, explains Giovanna Malara, Uoc director of Dermatology, Large Metropolitan Hospital of Reggio Calabria. “A recent sub-analysis of the Eclipse study showed that inhibition of IL-23, and not IL-17, would prevent this phenomenon and therefore significantly reduce disease flares,” he says. “In Janssen, immunology research is has always been at the forefront “, says Loredana Bergamini, Director of Medical Affairs Janssen Italy.” Since the advent of biological therapies, more than 30 years ago, we have developed the first monoclonal antibody targeting the immune system, providing patients with an effective solution that it could act in an important way on the symptoms. We have therefore continued to expand our knowledge of the inflammatory process and, thanks to this, we have been the first to develop therapies that intercept new inflammatory pathways and that can substantially improve the lives of patients. Our discoveries have changed the lives of millions of people around the world and – he assures – we continue to work for ever better treatments, capable of stopping and even curing immune-mediated diseases “.