This is an interesting article I just ran across. Not sure what to
think.
--- In RA-SUPPORT@y..., "Gina Walker" <Matsumura_Clan@m...
Psoriatic Arthritis: A Growth Industry
By Jennifer Huget
Special to The Washington Post
Tuesday, February 19, 2002; Page HE01
On Jan. 16 the National Psoriasis Foundation announced results of a
survey that showed that psoriatic arthritis -- a chronic, progressive,
inflammatory form of arthritis associated with the skin disease
psoriasis -- is more than three times as common as previously
believed.
According to the survey, the painful, unsightly and sometimes
debilitating disease affects as many as 1 million Americans.
That doesn't help the afflicted, but it's big news for Immunex Corp.,
a
Seattle biotech company that helped fund the survey and announced, on
the same day the survey was released, that its drug Enbrel had become
the first drug to receive U.S. Food and Drug Administration (FDA)
approval for treating psoriatic arthritis. Enbrel, already approved
for
and often used to treat rheumatoid arthritis, is expected by its maker
to reach $1 billion in sales this year. It costs about $12,000 per
year
to treat a typical user.
The survey (which another biotech firm with a stake in the psoriasis
market helped to fund) was done not by epidemiologists but by market
research firms. According to the National Psoriasis Foundation, the
researchers randomly selected 27,000 Americans and interviewed them by
phone. One-half of 1 percent of the survey group self-reported having
been diagnosed with psoriatic arthritis; the firm applied this figure
to
the U.S adult population to come up with the estimate of 1 million
adults having the condition. Previous estimates -- which for years
stood
at 300,000 and were raised to 500,000 by medical consultants just
prior
to the survey -- were based largely on percentage estimates of the
psoriasis population.
Psoriatic arthritis primarily affects people aged 30 to 50, but people
much older and much younger (including children) can suffer from it,
too. With symptoms that can include joint pain, swelling (particularly
in the hands) and thickened and pitted fingernails, the disease is
often
misdiagnosed or undiagnosed. Because its symptoms are similar to those
of rheumatoid arthritis, it is frequently mistaken for that disease.
In
other instances, its symptoms may seem so minor that patients don't
even
mention them to their physicians, who, in turn, might overlook them.
The situation is complicated by the fact that psoriasis patients
generally are treated by dermatologists, who aren't necessarily
focused
on recognizing arthritic symptoms. According to the National Psoriasis
Foundation, about 4.4 million American adults suffer from psoriasis, a
serious skin condition resulting from an overgrowth of skin cells.
The foundation's survey bore out the notion that psoriasis and
psoriatic
arthritis are closely linked: About 85 percent of those with psoriatic
arthritis also reported having psoriasis. Yet about a third of those
with psoriasis said they had joint stiffness but had not been
diagnosed
with psoriatic arthritis. That finding, the foundation notes, suggests
that a substantial number of people have psoriatic arthritis and don't
even know it. In fact, according to Kenneth Gordon, a dermatologist at
the Northwestern University Medical School in Chicago, some people
with
psoriatic arthritis don't even show any signs of psoriasis.
Gordon and his colleague Eric Ruderman, director of rheumatology at
Northwestern, are about to open what is believed to be the first
clinic
for the treatment of psoriatic arthritis. Their patients will be able
to
consult simultaneously with the skin doctor and the arthritis expert
and
to coordinate treatment. (Ruderman and Gordon have served as
consultants
for Immunex.)
In the absence of any drug specifically approved for treating
psoriatic
arthritis, doctors have for several years made off-label prescriptions
for Immunex's Enbrel, which had already been approved to treat
rheumatoid arthritis. But since many insurers won't cover off-label
uses
of a drug -- particularly one that costs $1,000 a month -- its use for
the condition has been limited. Doctors also draw on other drugs
usually
applied to rheumatoid arthritis: aspirin and ibuprofen to ease some
symptoms; systemic, disease-modifying agents such as methotrexate that
relieve symptoms and may slow disease progression and minimize joint
damage; and the immunosuppressant cyclosporine.
Enbrel, a "tumor necrosis factor-alpha" (TNF-alpha) receptor, is
expected to trump these treatments by interrupting the essential
mechanics of the disease.
But it will not be immediately available to all comers. Because demand
outstrips supply (new manufacturing sites are in the works),
prospective
patients must apply to be added to the Enbrel waiting list. Once they
get the drug, they need to be on the lookout for some serious side
effects, including heightened susceptibility to infection and,
apparently, the potential onset or exacerbation of multiple sclerosis.
(Enbrel carries a prominent label warning.)
If things seem a little cozy between Immunex and the National
Psoriasis
Foundation, they are, but perhaps no cozier than other drug makers and
the nonprofits they give financial support to. Foundation spokesperson
Molly Marshall says her organization purposely timed the release of
its
survey to coincide with the FDA's approval of Enbrel, hoping the
coincidence would spark media interest. "Past experience has shown the
press doesn't want to talk about psoriasis," Marshall said. (Those of
a
certain age will remember widely mocked television commercials
lamenting
"the heartbreak of psoriasis.")
Marshall suggests the survey's numbers may be imperfect, in that they
depended on people's accurately reporting their own symptoms and
diagnoses. "The only way to know the true incidence or prevalence is
to
bring people in to see the doctor and diagnose them," she said, adding
that chances for funding are remote.
For its part, Immunex says the new numbers, despite the fact that it
helped pay for them, won't much affect its marketing plan:
Spokesperson
Robin Shapiro says, "We always knew the market was several hundreds of
thousands of people, so in terms of market projection, there was no
substantial change."
In the meantime, watch this space: The Psoriasis Foundation data
released in January represent part of a larger survey conducted in
December 2001. The other part, dealing with psoriasis itself, is to be
released in April. The Boston biotech firm Biogen Inc. anticipates FDA
approval for its psoriasis drug, Amevive, by the end of the year. And,
yes, Biogen was the survey's other major funder.
Jennifer Huget is a frequent contributor to the Health section.
© 2002 The Washington Post Company
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