Psoriasis, a skin disorder expressed by dry, red reptile-like scales, is autoimmune, meaning cells in the body attack cells supposed to help put down the ailment. Several medicines exist, but not without effects that lead to more problems. In what amounts to a psoriasis coup, Can-Fite BioPharma found a way to clear skin and restore quality of life to those with this miserable disease, inciting no adverse consequences, and contained in a simple pill.
A fast journey, Can-Fite recently set its Phase III plan to use Piclidenoson, formerly CF101, in front of Europe’s EMA, our equivalent of FDA but quicker. EMA was receptive. The pivotal study will have all the proper scientific controls in place, where doctors don’t know if they’re handing out Piclidenoson or sugar pills.
Most important, planned global trials in 400 patients will pit Piclidenoson against the wildly-popular and lucrative Otezla (a blockbuster bringing in billions), from Celgene Corp. for psoriasis. Prior head-to-head studies against Otezla proved favorable and were subsequently published in highly-respected Journal of Drugs in Dermatology. As in the former study, Phase III will seek improvement versus placebo under medical-vetted psoriasis scoring as a first endpoint; the second will expect to show Piclidenoson equal to Otezla in efficacy.
Biologics for psoriasis are dangerous. Injectables operate to harness the immune system but fall short – side effects like respiratory illness are rampant, to name a few. Can-Fite’s drug works better. Two biochemical helpers – IL 17 and IL 23 are key. Can-Fite has found a way to employ these crucial players in the autoimmune disease of inflammation that represent different internal pathways than competitors.
Psoriasis affects millions worldwide – a medical market of $4 billion and growing exponentially. Can-Fite’s drug has shown safety and efficacy in 1,000 patients so far.
Piclidenoson brings information from cells of the body to enable certain functions in the body. How Piclidenoson works is elegant: it targets a biologically essential adenosine receptor to stop action that may result in disease, specifically autoimmune disorders where blood and organs attack themselves. Because Piclidenoson only works on ‘bad’ cells that cause inflammation, ‘healthy’ cells are spared; hence, the lack of detrimental side effects.
Inquiring about Can-Fite’s choice of receptor to study, I spoke to Pnina Fishman, CEO and founder of Can-Fite, who replied: “The reason we selected A3AR stems out of findings showing it is highly expressed on diseased cells but low expressed on normal cells. This makes it a specific target. This receptor doesn’t play a physiological role and is expressed when a disease evolves. So it does not mediate any adverse events”.
Two psoriasis pharma stars light up the medical sky – Celgene’s compound and another heavy-hitter from Johnson & Johnson, Stelara, which lists as bad side effects the risk of life-threatening allergic reactions, skin cancer, and blood leakage into the brain that may kill. Yet the drug is about to rake in $3 billion in 2016.
Piclidenoson works differently than Otezla, which is based on an asthma drug as I describe in an earlier article, and whose close biochemical cousin is used for erectile dysfunction. Otezla’s common side effects include unbearable migraine, diarrhea and vomiting and even thoughts of suicide, which led 6% of clinical trial patients to voluntarily stop treatment of the drug (see box below for a comprehensive list of psoriasis treatments).