Developments in PsoriasisManagement

Psoriasis (PsO) Is a Chronic Inflammatory Disease That CanImpact Patients’ Disease-Related Quality of Life

Patients May Avoid Treatment Due to Frustration

• PsO is a chronic, inflammatory disease with skin manifestations1,2 thought to result from an uncontrolled immune response1

• PsO has a substantial negative impact on patients’ emotional and social well-being3,4

• Itchy lesions5 and lesions affecting the soles,6 palms,6 nails,7 or scalp8,9 are particularly bothersome

• Evidence suggests psoriasis patients are at a higher risk for comorbidities such as obesity and heart disease10,11 which can add to their overall disease burden

Although systemic treatments are effective in treating psoriasis (PsO),12 many patientsdiscontinue treatment due to dissatisfaction with existing therapies13,*

* 57% and 45% discontinued oral therapies (n=820) and biologic therapies (n=389), respectively.† The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey is the first large-scale multinational survey of the prevalence of psoriasis and psoriatic arthritis. It was based on samplings of households in the United States, Canada, France, Germany, Italy, Spain, and the United Kingdom; 3426 patients and 781 physicians were surveyed in North America and Europe. ‡ Dermatology choice model survey assessing clinical decision drivers and activation levers in the treatment of psoriasis (N=151 dermatologists).

In a separate physician choice survey,‡ dermatologists reported that 6 of 10 patients withmoderate to severe PsO have never received systemic therapy, although an estimated2/3 would benefit14

2

In the MAPP survey,† most patients whoselesions were ≥4 times the size of their palmreported being on no treatment or topicaltreatment only 13>80%

Plaquepsoriasis

Psoriasis can beassociated with

many comorbidities

Reported Dissatisfaction With Available Treatment Options13,*

of patientsfound therapyburdensome13

50%

3

Many patients discontinue systemic therapybecause of safety & tolerabilty concerns13

% o

f Pati

ents

Who

Disc

ontin

ued

Beca

use

of S

afet

y or

Tole

rabi

lity

Conc

erns

50

40

30

20

10

0Oral Systemics Biologics

25%43%

N = 389N = 820

* Retrospective claims database study, using data from the MarketScan® commercial and Medicare databases from October 2008 to March 2011. Patient inclusion criteria included primary psoriasis diagnosis (ICD-9 CM 696.1 or 696.8 codes). Claims databases do not provide any information regarding the underlying reasons for therapy changes or discontinuations. Cost in US dollars, mean (standard deviation); P<.05 for switchers compared with non-switchers.

4

Real-World Analysis Revealed a Marked Increasein Healthcare Utilization and Costs

Within 1 year of initiating biologic therapy, 25% of patients completely discontinue treatment15,*

Total healthcare costs per patient*

Parameter Switchers

Discontinuers

Non-switchersPure

discontinuersRe-intiators:

Same therapyRe-intiators:

Different therapy

38,529 (24,328) 32,822 (15,913) 21,775 (25,483) 39,241 (29,266)

All-cause hospitalization cost 1,713 (12,529) 911 (4,663) 3,105 (14,425) 3,213 (14,342)

All-cause outpatient service cost* 6,562 (11,802) 4,622 (9,788) 6,723 (16,328) 11,222 (18,640)

All-cause ER visit cost* 447 (1301) 266 (1,001) 448 (1,3004) 1,206 (7,335)

All-cause physician office visit cost* 795 (522) 668 (558) 775 (918) 896 (701)

All medication cost* 30,303 (12,935) 27, 313 (11,706) 12,061 (8,254) 24,837 (13,297)

Lab test cost 50 (282) 36 (298) 148 (850) 377 (2,047)

Radiotherapy cost 760 (5002) 415 (2,076) 1,180 (9,672) 941 (2,075)

29,420 (18,287)

998 (7,024)

4,802 (8,200)

310 (1,057)

681 (538)

23,619 (14,826)

64 (1,153)

411 (1,090)

Patients who discontinue therapy cost plans an average of $21,775 annually15

5

PDE4 Is a Key Intracellular Enzyme Involved in Modulatingthe Immune Response in Psoriasis

Over the last several decades, research and treatment have focused on extracellular cytokinesinvolved in psoriasis. Recent research, however, has identified important signaling moleculeswithin immune cells. One such molecule, phosphodiesterase-4 (PDE4), is a key intracellularenzyme involved in modulating immune cell activity in psoriasis.

PDE4 is the predominant intracellular cAMP-degrading enzyme within a variety ofinflammatory cells, including eosinophils, neutrophils, macrophages, T cells, and monocytes16

By breaking down cAMP into its inactive form AMP, PDE4 promotes immune cell activation and the release of proinflammatory cytokines, while indirectly decreasing the productionof anti-inflammatory cytokines.

cAMP

AMP

PDE4

Pro-inflammatorycytokines (TNFα,IL-17, IFN-ᵞ)16-18

Anti-inflammatorycytokines (IL-10)19

Immune cell

1. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361:496-509.

2. Mehta NN, Yu Y, Saboury B, et al. 2011;147:1031-1039.

3. Magin P, Adams J, Heading G, et al. Psychol Health Med. 2009;14:150-161.

4. Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. Arch Dermatol. 2010; 146:891-895.

5. Yosipovitch G, Goon A, Wee J, et al. Br J Dermatol. 2000;143:969-973.

6. Pettey AA, Balkrishnan R, Rapp SR, et al. J Am Acad Dermatol. 2003;49:271-275.

7. Augustin M, Reich K, Blome C, et al. Br J Dermatol. 2010;163:580-585.

8. Heydendael VM, de Borgie CA, Spuls PI, et al. J Investig Dermatol Symp Proc. 2004;9:131-135.

9. Jaliman D. Scalp psoriasis. 2013. http://www.webmd.com/skin-problems-and-treatments/psoriasis/scalp-psoriasis. Accessed July 14, 2014.

10. Love TJ, Qureshi AA, Karlson EW, et al. Arch Dermatol. 2011;147:419-424.

11. Boehncke WH, Boehncke S, Tobin AM, Kirby B. Exp Dermatol. 2011;20:303-307.

12. Mustafa AA, Al-Hoqail IA. J Taibah U Med Sci. 2013;8:142-150.

13. Lebwohl MG, Bachelez H, Barker J, et al. J Am Acad Dermatol. 2014;70:871-881, 881.e1-881.e30.

14. Data on file, Celgene Corporation.

15. Mallya U, Lahoz R, Qureshi A. American Academy of Dermatology 72nd Annual Meeting; March 21-25, 2014; Denver, CO.

16. Bäumer W, Hoppmann J, Rundfeldt C, Kietzmann M. Inflamm Allergy Drug Targets. 2007;6:17-26.

17. Souness JE, Griffin M, Maslen C, et al. Br J Pharmacol. 1996;118:649-658.

18. Ma R, Yang BY, Wu CY. Int Immunopharmacol. 2008;8:1408-1417.

19. Oger S, Mehats C, Dallot E, et al. J Immunol. 2005;174:8082-8089.

www.discoverPDE4.com

References

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