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May 2018
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Speaking with the experts: Dr. Melinda Gooderham
In our final chat with Dr. Melinda Gooderham, we talk about the different types of treatments that were in our January newsletter. 
 
As we heard at that time, Dr. Gooderham noted that there has been significant research and development in the types of psoriasis treatments available on the market. Specifically, we’ll be taking a deeper dive into the following treatments:
  • Topical treatments
  • Calcineurin inhibitors
  • Phototherapy
  • Systemic therapy
  • Biologics
Topical treatments
 
Topical treatments are often prescribed to patients dealing with mild-to-moderate psoriasis – those with psoriasis on 3% or less of their body surface area. These treatments can be both steroid and non-steroid and are often applied to the face, skin fold, and scalp areas.
 
Calcineurin inhibitors
 
This treatment targets the cells that cause psoriasis and is non-steroidal. Calcineurin inhibitors are designed to work on the immune system to reduce inflammation. They’re non-steroidal and work mainly for face and folds. Older forms of calcineurin inhibitor treatments are Coal Tar and Anthralin, however they’ve fallen out of favour as they aren’t as effective as some of the newer treatments.

Phototherapy
 
Also known as light therapy, phototherapy exposes the skin to wavelengths of light.
 
One form is known as PUVA – and is a combination of UV-A light exposure after taking a Psorelan, a drug taken orally, which enhances the effect of the UV-A light. This method has fallen out of favour as it has been linked to skin cancer.

A more commonly prescribed treatment is UVB phototherapy.


Above: Dr. Melinda Gooderham,
Dermatologist, SKiN Laser Clinic.


Using this method, the exposure time is very short, ranging from a few seconds to a few minutes, with varying intensity depending on a patient’s skin pigment and sensitivity.

Systemic therapy
 
Systemic therapy is an older and more traditional form of treatment for psoriasis. Also known by market-names Methotrexate and Cyclosporine, these therapies are used for very severe cases of psoriasis. However, due to the side effects associated with these treatments they’re not suitable for those with co-morbidities such as liver diseases, diabetes, and other illnesses.
 
Biologics
 
Biologic treatments can be very successful treatments, but there are some risks associated with them. Biologic drugs work by blocking processes in the immune system that create the inflammation of psoriasis.
 
The traditional first generation of biologics is known as Humera – and has been used to treat a number of inflammatory diseases including psoriasis, psoriatic arthritis, and inflammatory bowel disease – all illness that can be associated with psoriasis.
 
While these drugs were considered a major advance in the treatment of psoriatic disease, there are risks.
 
Today, there are a number of treatments that align with a patient’s need. The key is to know that there are options, and you can talk to your doctor about the one that best treats your severity and your lifestyle.

Learning to Live with Psoriasis: Christine McKarney's Story
It started with a sore throat that lasted for a few days. Then spots started appearing. Everywhere. Slowly at first, but eventually I was covered enough to see the doctor about it. She referred me to a dermatologist, who gave me a diagnosis of guttate psoriasis. At that point I had never heard of psoriasis and didn't know what it was. I did a lot of research and reading on the internet. That was when the reality of the situation sunk in for me – 'life-long condition', 'no cure', 'various treatment options'. These were not the magic cures I'd been hoping to find.

By clinical standards, I currently have mild psoriasis, meaning the spots cover less than 3% of my body. However, the spots seem to have become almost permanent. Topical creams initially worked for me, but lost their effectiveness over time. Truthfully, if it weren't for the incessant itching, I probably wouldn't seek treatment at all. Once topical treatments fail, systemics, biologics, and biosimilars are next, and I'm not prepared for the potential side effects considering that I'm considered a mild case. The itching can be very distressing, and treatments can be inconvenient and messy. Relatively speaking though, I consider myself fortunate. While my spouse had to adjust to the changed me, and my treatments, I would have found it much more difficult socially if I had developed psoriasis as a child. Dating is difficult for everyone, but more so for someone with psoriasis.

When diagnosed with psoriasis, depression is normal. Learning that you will be carrying this condition around for the rest of your life can be despairing, and if you don't find the right treatment options right away, things can feel hopeless. But as time passes, you learn that you are not your disease and you do not have to be defined by it. It doesn't happen overnight, but you do get there, and you realize that you'll find joy again. It won't be the same as before, but why should it be? You aren't the same and your experiences won't be the same either.


Above: Christine McKarney.

Advocating for myself, my health, and my treatment has been one of my hardest lessons. Being raised to obey authority without question led me to rely heavily on the opinions of doctors and to ask them what they think I should do. But my doctor told me that it's my decision as to whether I want to continue on the trail and what I want to do next. The change in mindset takes time, but it makes the health care journey collaborative, so I feel like I have some control over my life and my health. I still want a cure more than almost anything.

Recently I was invited to take part in a clinical trial for a topical cream, hoping to help others with psoriasis. If you are considering a trial, consider the time commitment required for the treatments and follow-up appointments. It will take more of your time that you expect. Taking part in a clinical trial is an interesting experience. You don't know what product you are using, or whether you are using the product or a placebo. While I hoped that participating in the trail would help me with my stubborn spots, I realized that I won't benefit as much from the info gathered in the trial as future generations. If there is no cure found soon, I hope that young people have many choices for effective treatment and a better life.

Quality of life matters, and speaking up for yourself is important, especially considering how common depression is with this condition. Be your own cheerleader and advocate to live your life to its fullest. And above all, don't give up.
 

We Want to Hear From You
Are you living with psoriasis? Do you have a story or a lesson you'd like to share with the psoriasis community about life with the autoimmune disease? Maybe you have a loved one who'd like to share their experience? We're looking for guest bloggers to share their stories and we'd like to hear from you. If this sounds like something you'd be interested in, please contact Glenn Hendricks at executivedirector@cpn-rcp.com.
For Your Information: Clinical Trials in Canada
Finding the right medication to treat a chronic illness can be an exhaustive search for some people. For others, that search may be an opportunity to both find some relief and help others along the way. For those in the second group – participating in a clinical trial may provide an opportunity to be a part of something different while treating an illness in a new way. But how do clinical trials work and how do you know if that option is right for you?
 
In this country, clinical testing involving drugs actually happens along a spectrum, with many phases required before they ever get to a human trial stage. Health Canada itself does not sponsor or conduct drug research – pre-clinical and clinical testing is done through a sponsor: this would be a drug company, or researchers from a hospital, university, or other research organization. Rather, Health Canada acts in an oversight capacity and reviews all applications to ensure:
  • the use of the drug in the patients being studied is appropriate
  • any risk associated with the use of the drug is minimized as much as possible
  • the best interests of the people participating in the trial are upheld
  • the objectives of the trial are likely to be achieved
After a pre-clinical study is completed, and promising results are reported, the sponsor of the trial then pursues a clinical trial. There are four research phases for clinical trials in Canada.

They are:

Phase one: Healthy patients with approximately 20-80 participants
Phase two: First evaluation in patients with the target disease, with approximately 100-300 participants

Phase three: Patients with the target disease, with approximately 300-3,000 participants

During phase three, the sponsor must answer questions about the long-term safety of the drug, how the drug compares to current medications on the market, and how the drug compares to a placebo.
 
After phase three is completed successfully, the drug can be submitted for Health Canada approval and eventual use by the general population. Once approved, the new medication can then be marketed. 

Phase 4: Patients with the target disease, with variable and large numbers of the general population.
 
During this final phase, the sponsor continues to collect information regarding the optimal use, efficacy, and safety of the drug in the general population, as well as looking at how it performs against other medications already on the market, and finally how the medication affects the patients’ quality of life.

There are a number of reasons you might be interested in participating in a clinical trial – but the number one thing you should do is get educated on your options and what it means for you and your family. If participating in a clinical trial is of interest to you, we encourage you to seek out as much information as you can through our website, by visiting our Clinical Trials page.

(Written with information from Health Canada and the Canadian Psoriasis Network.)

Ask the Expert: Dr. Bourcier talks about management of a Chronic Skin Condition in this third of five videos produced by the Canadian Psoriasis Network.
WHAT'S HAPPENING IN THE WORLD OF PSORIASIS
Each month we'll share a list of psoriasis-related links we think are interesting. Have you read anything you think we should share with the Network? Share your links with us on Facebook, Twitter, or via email.

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