Updates in Psoriasis Treatment

At Interdisciplinary Autoimmune Summit 2020, Joel Gelfand, MD, MSCE, professor dermatology and epidemiology at University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania, discussed the latest advances in the management of psoriasis.¹

Dr Gelfand reviewed the prevalence of this disease, noting that some studies showed patients with skin of color are more likely to have moderate to severe disease compared with White patients. Patients with skin of color are also less likely to be treated with biologics compared with White patients, he added. In addition, Dr Gelfand discussed studies on the impact of psoriasis on quality of life. A notable clinical trial showed that patients who were withdrawn from therapy to see if they experienced a flare showed that losing control of the disease was more challenging for patients.

Psoriasis can be a very isolating and stigmatizing disease. In one study, 40% of lay persons said they did not want to shake the hand of some with psoriasis. Another study Dr Gelfand reviewed found a percentage of laypersons thought psoriasis was contagious. “This is a specific challenge now during the global pandemic where having a rash is often misconstrued by the lay population as meaning you are contagious and we need to recognize this as an added burden for patients with visible diseases,” stated Dr Gelfand.

When selecting a treatment, Dr Gelfand said he considers how much the disease is bothering a patient, objective signs of the disease, and any underlying health issues a patient may have.

The International Psoriasis Council’s Consensus Statement classifies patients with psoriasis as either candidates for topical therapy or candidates for systemic therapy.² Candidates for systemic therapy are defined as:

• 10% or more affected body surface area 
• Disease in special areas (eg, face, genitals)
• Failure of topical therapy

Psoriasis Area and Severity Index (PASI) of 90% is now considered the gold standard because it is clinically meaningful for patients, Dr Gelfand noted. Long-term disease control is also important for patients as well as providers, he added. In a clinical trial, patients who were withdrawn from risankiumab after achieving clear or almost clear scores were found to maintain PASI 90 for a median of 210 days, and it took nearly 300 days for them to relapse.

 In addition, Dr Gelfand reviewed drug survival and loss of response overtime. Factors associated with loss of response include obesity, smoking, worse quality of life, already failed a biologic therapy, and female sex. “Previous failure to a biologic therapy really impacts my decision,” said Dr Gelfand. For patients who report failing a biologic therapy, he is more likely to increase the dose or add methotrexate in order to prolong the survival so that the patient does not run out of treatment options.

He also addressed the current concerns regarding the COVID-19 pandemic among patients with psoriasis. According to Dr Gelfand, the data regarding COVID-19 in patients with psoriasis being treated with biologics is largely reassuring so far. Many therapies, such as apremilast and IL-17 inhibitors, are being investigated as a potential treatment option for patients with COVID-19. At this time, patients are recommended to continue their biologic therapies, he added. “We know living with the pandemic means more social isolation and stressors, so the last thing we want to do is add to this burden by having patients deal with uncontrolled psoriasis,” he said.

For more coverage of IAS 2020 virtual, visit the newsroom.

–Melissa Weiss

Reference

1. Gelfand J. The current state of psoriasis treatment with target therapy. Presented virtually at: Interdisciplinary Autoimmune Summit; July 10, 2020.

2. Strober B, Ryan C, van de Kerkhof P, et al. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol. 2020;82(1):117-122. doi:10.1016/j.jaad.2019.08.026