The skin condition psoriasis affects more than 6.7 million adult men and women, leading to scaling and inflammation. The outward skin changes actually start deep within the skin, when skin cells rise too quickly to the surface of the skin which leads to them piling up on the surface in an immature state. The end result is typically patches of thick, red skin along with a cover of silvery scales. These psoriasis patches (also known as plaques) can feel itchy or sore. The discomfort can be severe enough to interfere with sleep, mobility, and activities of daily living.
Given the large number of people affected by psoriasis and the potential seriousness of this condition, research continues in earnest to provide relief and healing. The latest research suggests that the best course of action could be early use of tumor necrosis factor inhibitors (anti-TNFs) in newly diagnosed patients who have both plaque psoriasis and psoriatic arthritis. This treatment is a cost-effective choice that generally offers good outcomes. For patients with psoriatic arthritis (without plaque psoriasis symptoms), the medication apremilast continues to be a financially sound first-choice treatment.
The research that came to this conclusion followed psoriasis patients for one year, tracking costs and outcomes. The anti-TNF treatments included adalimumab, etanercept, infliximab, or golimumab. The initial anti-TNF treatment in patients with both plaque psoriasis and psoriatic arthritis brought about better outcomes after one year, compared to those started on apremilast but delayed in the use of TNF treatment; this also came at a lower cost by the end of the year treatment period (which was a surprise, considering the lower cost of apremilast).
Strand V, Husni E, Griffith J, et al. Economic evaluation of timely versus delayed use of tumor necrosis factor inhibitors for treatment of psoriatic arthritis in the US. Rheum Ther 2016 doi:10.1007/s40744-016-0042-2.