What to Expect at the IAS Virtual Meeting: Q&A With Dr Gelfand

—Melissa Weiss

This year’s Interdisciplinary Autoimmune Summit (IAS) will continue to bring together experts from various fields to discuss the care of patients with immune-mediated inflammatory diseases–but this time, in a virtual format. While the in-person event was cancelled due to the COVID-19 pandemic, attendees can still expect to learn about the latest updates in care and connect with colleagues and experts from the comfort of their own home.

IAS Senior Advisor Joel Gelfand, MD, MSCE, will discuss updates in psoriasis treatment, current data on the effects of therapies on cardiovascular risk, and the impact of COVID-19 on patients with autoimmune diseases. He shared some insights into what he will be presenting and why continuing to host IAS on a virtual platform is important for providers treating patients with complex autoimmune diseases.

Dr Gelfand is a professor of dermatology and epidemiology, vice chair of clinical research and medical director of the Dermatology Clinical Studies unit, and director of the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania Perelman School of Medicine in Philadelphia, PA.

ALN: Why is it important for conferences such as IAS to continue delivering education virtually this year, especially as the pandemic wears on?

Dr Gelfand: IAS is a very unique conference because it is so multidisciplinary. It is unusual for CME conferences to involve multiple specialties the way IAS does. That is a key distinction.

Of course, this pandemic and the COVID-19 disease affects multiple specialties. We need to be aware of what is going on, in terms of how to best identify these patients, diagnose them, treat them, as well as how to manage our practices and our staff so we can deliver safe and effective medical care.

ALN: What can an attendee expect from the virtual IAS meeting this year?

Dr Gelfand: I think it will be just as engaging as our in-person conference, but a lot more convenient for attendees because they will not have to get on a plane or drive to New York City. Attendees can expect a lively, engaging, very up-to-date conference, brewing with important medical information for clinical practice.

ALN: What will you be presenting at the conference?

Dr Gelfand: I will be presenting on a variety of different topics at the meeting. One of my presentations will cover the effect of cardiovascular disease (CVD) risk in the autoimmune community. In that presentation, we will look at how therapies used to treat immune-mediated inflammatory diseases can potentially prevent CVD, such as methotrexate, IL-1 inhibitors, and colchicine. I, as well as others, have performed a series of rigorous, randomized, placebo-controlled trials that will give us insight into whether treatment lowers the risk of CVD and other major medical comorbidities. Also, I will talk about the most recent guidelines on how to manage methotrexate safely and effectively, such as more cutting-edge ways of monitoring for liver toxicity.

I will also be discussing targeted therapies for psoriasis, which have completely revolutionized the treatment of this disease. We are able to achieve levels of clearance for a complex, immunologically mediated disease, as well as achieve remission in more patients with psoriasis, far beyond any other autoimmune disease, including Crohn disease, rheumatoid arthritis, and multiple sclerosis.

ALN: This meeting will include a roundtable discussion about the impact of COVID-19 on patients with autoimmune diseases between your, Cassandra Calabrese, DO, Leonard Calabrese, DO, and Stephen B. Hanauer, MD, FACG. How has the pandemic impacted your practice and patients with psoriasis?

Dr Gelfand: It has impacted all of us in major and profound ways. First of all, it has significantly impacted our clinical interactions. In my own practice, almost everything we are doing is through telemedicine, because we are not seeing anyone in the office right now in Philadelphia unless it is necessary. For example, I had a patient who needed a biopsy because I identified a melanoma.

People are understandably concerned about the safety of their immunomodulating therapies during the pandemic. Also, a lot of people are dealing with social isolation, anxiety, and depression that is associated with social distancing. This can be a double whammy for people with psoriasis.

However, it may help a lot of us understand some of the experiences people with psoriasis go through. For example, during Memorial Day weekend, everyone wants to go to the beach, wear shorts or swimsuits, and have fun. Psoriasis is visible for a lot of people, and they feel like it is a prison for them. They feel they cannot go out in shorts or wear more revealing clothing because having visible psoriasis is very stigmatizing.

If those of us who treat psoriasis cannot help our patients get their psoriasis under control, then not only do our patients feel bad about the pandemic, social distancing, and economic issues, but they also have to cope with their disease on top of everything else.

When trying to balance the risks and benefits with patients individually, I personally mostly favor keeping them on their respective therapy. The few patients who have stopped their treatment had actually fairly mild disease, they had completely cleared disease, we did not really know for sure if they needed to stay on it, and they had risk factors associated with severe outcomes for COVID-19. They were older and had CVD or hypertension. I also have some young, healthy patients stop their medications because they are quarantined at home with family members, some of whom are elderly, and they are worried about contracting the infection and spreading it to their grandparents. That is a big burden for people to weigh when they decide whether or not to stay on these medications. As their physician, I try and support their decision and give them the best data I have available so we can make that decision together. I tell any patient who decides to stop their medicine that if they see any signs of their disease coming back, to let me know and we will discuss it. I let them know that they should consider restarting therapy before their condition gets too bad.

ALN: Are there any new developments for psoriasis or psoriatic arthritis that are either out or in the pipeline that you are excited about?

Dr Gelfand: IL-23 inhibitors are now being studied for psoriatic arthritis, and the initial trials are quite promising, possibly exceeding our expectations because people felt the IL-23 mechanism might not be as good as the tumor necrosis factor mechanism. Another therapy is bimekizumab, which binds to and neutralizes IL-17A and IL-17F and seems to be effective at previously unforeseen levels and will be further tested in a phase 3 trial.

TYK2 inhibitors are newer oral molecules that have the efficacy of some biologics, which is a big advance because our current oral medications, such as methotrexate or aremilast (Otezla), do not have the same level of efficacy for our patients. Having an oral option that works just as well as an injectable would be a really great treatment advance for our patients.

You can join Dr Gelfand at the virtual IAS meeting by registering here.