Most autoimmune diseases don’t have cures. Here are the top ways providers can manage and control them.
Most autoimmune diseases don’t have cures. Therefore, physicians try to manage and control them.
“Although many good treatments exist, many patients still suffer with uncontrolled disease and side effects from medications,” says Cynthia Marie Carver DeKlotz, MD, pediatric and adult dermatologist at MedStar Washington Hospital Center and Georgetown University Hospital, and assistant professor of clinical medicine and pediatrics at Georgetown University School of Medicine, all based in Washington, DC. “New and improved treatments are needed.”
Ryan Foster, PharmD, MBA, senior director of pharmacy at Spectrum Health in Grand Rapids, Michigan, says treatment options for many autoimmune conditions are relatively simplistic. “Although advances are being made in personalizing autoimmune treatments, the mechanisms by which current drugs work are limited,” he says. “As our understanding of the underlying etiology of conditions grows, so does our ability to develop targeted therapy options. This will allow providers to create more personalized treatment plans.”
Currently, clinicians choose a particular agent based upon a disease’s clinical features, the patient’s characteristics, such as having other comorbidities and their lifestyle, previous treatment failures, and/or formulary restrictions, says Ronald F. Maceyko, MD, director of the Division of Dermatology at the Autoimmunity Institute, AHN-West Penn Hospital.
Often, the treatment initiated for one type of autoimmune condition can help another one, such as a treatment for psoriasis might also help psoriatic arthritis and inflammatory bowel disease.
Here are four ways treatments for autoimmune conditions could change.
Regarding their use clinically, substantial research and time will tell if a biosimilar proves to be as safe and efficacious as an original biologic medicine. “I believe those factors, in addition to patient access, will ultimately determine if they gain popular use clinically or not,” DeKlotz says.
Recent studies project that biosimilars could reduce spending on biologics between $25 to $150 billion over the next 10 years. This is on top of cost savings from lower-cost generics, which now represent 90% of all medicines given to patients, says Andrew Powaleny, director of public affairs, Pharmaceutical Research Manufacturers of America.
“Small molecules” as opposed to the very large molecular structure of biologic agents, are a group of newly discovered oral medications that interrupt enzyme signaling pathways between cells that cause inflammation. These include apremilast (Otezla) and tofacitinib (Xeljanz), which have demonstrated efficacy in psoriasis, says Maceyko. Other experimental signaling inhibitors show great promise in treating psoriasis and are anticipated to benefit other autoimmune disorders.
“If we are able to find viable treatments that target the root cause of autoimmune conditions, we will be on the path toward a cure,” Foster says. “Although no such therapies are near approval, there are new therapies in research and development.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.