A Quest to Cure Psoriasis
The National Psoriasis Foundation launches an effort to eradicate the disease once and for all.
In March 2018, more than a dozen scientists on the Scientific Advisory Board of the National Psoriasis Foundation (NPF) huddled in a hotel conference room in Old Town Alexandria, Virginia. Our mission: discuss the steps needed to discover and create a permanent cure for psoriasis and psoriatic arthritis.
What was once the stuff of science fiction now has a basis in reality. With some of the current biologic therapies, up to 90% of psoriasis patients can achieve significant improvement in their skin and up to 50% of patients can achieve complete clearance of their skin for 5 years or longer. Scientific advances have allowed researchers to learn more about the genetics and immunology of psoriasis than any other inflammatory skin disease. Already, 2 psoriasis auto-antigens have been discovered, and new technologies such as CRISPR gene editing and chimeric antigen receptor (CAR) T-cell therapy hold promise for targeting psoriatic disease in new ways. Thus, aiming for a psoriatic disease cure now seems within grasp.
Still, the task is a daunting one. Psoriasis is a complex disease, and although many patients do well on newer therapies, some of these patients relapse due to unknown factors. Psoriatic arthritis responds less well to current treatments, and no diagnostic test for psoriatic arthritis yet exists. NPF’s psoriatic disease researchers felt that a cure effort would take at least a decade to bear fruit. However, they were excited that the time was right to initiate such an effort. NPF is committed to leading a path forward for a cure.
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What are the next steps? Already, the NPF is convening patients, researchers, and industry representatives to first define what a “cure” means. For some, a cure means permanent absence of symptoms without therapy, while for others the remission of disease for a 1-year period constitutes the first step toward a cure. The NPF is sponsoring a series of Delphi exercises to reach consensus on a cure definition.
In 2019, the NPF aims to hold our first Cure Conference, assembling the brightest minds in the field to discuss innovative strategies for developing a cure. NPF recognizes that a successful cure effort will require the participation of many stakeholders, including patients, clinicians, academic investigators, industry leaders, the National Institutes of Health (NIH), medical societies, payers, and ethicists. This effort will also require new sources of funding to pursue high-risk, high-reward ideas.
Psoriatic disease researchers are not alone in their quest to identify a cure for a medically complex disease. In 2010, the HIV research community and International AIDS Society began its “Towards an HIV Cure” Initiative. The parallels between the 2 disease states is quite interesting. Antiretroviral therapy can effectively suppress HIV replication over many years. However, patients require lifelong therapy, drug resistance and toxicity can emerge, persistent immune dysfunction may occur, and patients experience social stigma and high economic costs. Thus, the HIV community established a global strategy to develop a HIV cure, with 7 scientific working groups focusing on areas such as HIV latency, viral reservoirs, gene or cellular therapy, novel biomarkers and technologies, and social implications of cure research. To date, with the participation of academia, industry, NIH, World Health Organization, UNAIDS, amfAR, European AIDS Treatment Group, and other organizations, the HIV cure effort has raised more than $200 million in research funding.
Other bold cure efforts are underway. The Chan-Zuckerberg Initiative has pledged $3 billion to cure, prevent, or manage all diseases by 2100. And Congress has authorized $1.8 billion for the Cancer Moonshot Initiative over the next 7 years.
A Cure Is Out There
With new scientific technologies emerging and excellent psoriasis therapies already in existence, the time has never been better to think about achieving the ultimate goal: a cure for psoriatic disease. Such a goal can be accomplished if the international psoriatic disease community comes together to focus its energy and resources on this important task. The time to act is now—and if we do and are successful, a child suffering today with psoriasis or psoriatic arthritis will have an eminently brighter future.
Dr Liao is an associate professor of dermatology at the University of California San Francisco and the chair of the NPF’s Scientific Advisory Board. For more information on how you can help support a cure for psoriatic disease, email email@example.com.