Adalimumab (Humira) is intended to be used as a second line therapy for the treatment of children and adolescents with severe chronic plaque psoriasis that is inadequately controlled by, or contraindicated for, topical and/or phototherapy. If licensed it would offer an additional treatment option for such patients. Adalimumab is a fully human immunoglobulin G1 monoclonal antibody that binds with high affinity to TNF Î±, which blocks its interaction with the p55 and p75 cell surface TNF receptors, and modulates biological responses that are induced or regulated by TNF. Adalimumab is currently licensed in the EU for the treatment of psoriasis, rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
The estimated overall UK prevalence of psoriasis is 1.5-2.2%, with 1.1% of affected people suffering severe disease. The prevalence in children and adolescents is related to age, being 0.55% in those younger than 10 years of age, and 1.4% in those aged between 10 and 19 years. Juvenile psoriasis is associated with increased rates of Crohn’s disease, hyperlipidaemia, obesity, hypertension, diabetes mellitus, and rheumatoid arthritis. Patients with psoriasis often experience feelings of self-consciousness and embarrassment, and as a result may suffer unemployment, social isolation and depression; all factors which contribute to a reduction in overall patient quality of life.
Treatment options for psoriasis aim to reduce symptoms and improve the quality of life of patients and their families/carers. In all age groups, topical treatments are usually offered as first line therapy, followed by phototherapy and/or systemic therapies as second line treatment, and biological therapies as third line treatment. Adalimumab is currently in one phase III clinical trial comparing its effect on measures of the area of psoriasis and its severity against treatment with methotrexate. This trial is expected to complete in December 2015.
Secukinumab as a subcutaneous injection is in clinical development for the treatment of enthesitis related arthritis (ERA) and juvenile psoriatic arthritis (JPsA). These conditions belong to a group of arthritis conditions of unknown cause known as juvenile idiopathic arthritis which affect children. JPsA patients have arthritis and psoriasis, an inflammatory skin disease and ERA patients have arthritis and enthesitis, inflammation of the ligaments and tendons. These conditions are the result of the immune system mistakenly attacking the body’s own cells at the joints and the skin or tendons, causing swelling, pain and reduced mobility.