PBS listing could save psoriasis patients tens of thousands a year

According to the Federal Government, without a Pharmaceutical Benefits Scheme (PBS) subsidy the new listings – guselkumab (sold as Tremfya) and tildrakizumab (sold as Ilumya) – would cost patients $30,200 or $32,600 per year, respectively.
 
However, both subsidised medicines will be available for $40.30 per script from February, with approximately 10 scripts required annually for patients with severe chronic plaque psoriasis.
 
Concessional patients will be able to access the medicine for $6.50 per script, with the medicines expected to benefit around 3600 Australians with the chronic form of the disease.
 
While there is no ‘cure’ for psoriasis, biological therapies have dramatically improved the prospects of managing the condition, to the point where patients are seeing a 90% reduction in the psoriasis area and severity index, in both the short term and long term.
 
Treatment with guselkumab neutralises the activity of a protein IL-23, and reduces proteins in the skin responsible for forming the plaques seen in psoriasis, whereas tildrakizumab reduces inflammation and other symptoms of the disease, while promoting skin clearance.
 
Dosing schedules have also improved, from weekly treatments to intervals of two to three months in some cases.
 
Despite the progress, clinical dermatologist Associate Professor Peter Foley believes the medicines are still underutilised.
 
‘It would appear that a significant portion of patients are not presenting to their GPs because they are not aware that newer, less toxic therapies are available or they have been told years ago that there is no cure,’ he wrote in MJA Insight.
 
‘The poor dissemination of information to GPs of the available therapies has potentially resulted in delayed referral to dermatologists. The newness of this class of therapy and the broader ranging action of the early biologics may [also] have resulted in some dermatologists being reluctant to prescribe the agents.’
 
According to Associate Professor Foley, around 2.3% of Australians will manifest clinical signs of psoriasis, with the autoimmune disease generally appearing from teenage years into early adulthood.
 
Aside from the debilitating red, scaly lesions that are the most obvious manifestation of the disease, psoriasis is also associated with higher rates of anxiety and depression, and has an increased frequency of multiple comorbidities.
 
The systemic nature of chronic plaque psoriasis means patients are at greater risk of metabolic syndrome and cardiovascular disease, as well as associated risk factors, including obesity, diabetes hypertension, dyslipidaemia and non-alcoholic fatty live disease.
 
‘Independent of these individual risk factors, psoriasis appears in itself to be a risk factor for myocardial infarction and cerebrovascular accident. Added to this are lifestyle factors of increased prevalence of cigarette smoking and higher alcohol consumption,’ Associate Professor Foley wrote.
 
‘Extrapolation from the rheumatology literature would suggest that control of systemic inflammation results in decreased cardiovascular morbidity and mortality, hopefully indicative of a similar benefit in the psoriasis population.
 
‘With new targeted therapies and enhanced education, more patients with this condition, with its profound impact on quality of life … will be the beneficiaries of the advances and we will have happier, healthier patients.’

dermatology PBS Pharmaceutical Benefits Scheme psoriasis