Roflumilast: A New Topical Treatment for Psoriasis

Neal Bhatia, MD: One of the newer agents to the market for psoriasis is roflumilast, which is a 0.3% cream. Basically, it works as a phosphodiesterase-4 inhibitor. If you’re not familiar with that, it’s basically turning off the conversion of cyclic AMP [adenosine monophosphate] to AMP, which creates the donation of phosphorus to do other components of cytokine activation, as well as some of the other cellular mechanisms that are important. It’s a very broad-acting enzyme. We’ve seen it before in many different formulations, both orally and topically, for atopic dermatitis as well as for psoriasis in the past. The nice thing that we’re seeing about roflumilast is its potency, its impact on the enzymatic process as well as what it’s doing overall to reduce inflammation from that conversion. I think even more so, in regard to what roflumilast does, we’re seeing very little in terms of permeation that’s causing some of the potential adverse effects or systemic adverse events we are seeing with oral therapies, but we’re still seeing the potency also. The nice thing too about the delivery is the cream, now we’re seeing a cream that we can use to improve the plaque outcomes even on the scalp and the genitals, where once we were relying on ointments, foams, and solutions, where the tolerability may not have been as good.

Between having a very potent molecule that is improving the impact on inhibition of phosphodiesterase-4 as well as from what we’re seeing with the vehicle, the cream, which unlike some of its predecessors, does not have the issues of burning and stinging and some of the tolerability issues because of the base, I think we’re getting a lot of potential utility from where this agent can help us down the road.

Transcript Edited for Clarity