Psoriatic Arthritis: A Growth Industry

[Guest guest]

Psoriatic Arthritis: A Growth Industry

By 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 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 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.

Huget is a frequent contributor to the Health section.

© 2002 The Washington Post Company

[Guest guest]

This is an interesting article I just ran across. Not sure what to

think.

Psoriatic Arthritis: A Growth Industry

By 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 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 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.

Huget is a frequent contributor to the Health section.

© 2002 The Washington Post Company

--- End forwarded message ---

[Guest guest]

Dear Meghan...Think money..think profits... It's all the bottom line...Isn' t

it great? E.M....

meghan_e <meghan@...> wrote: This is an interesting article I just ran

across. Not sure what to

think.

Psoriatic Arthritis: A Growth Industry

By 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 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 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.

Huget is a frequent contributor to the Health section.

© 2002 The Washington Post Company

--- End forwarded message ---