Translating Evidence Into Practice: Biologics
Joel Gelfand, MD, presented on emerging therapies and management strategies for patients based on the latest information on biologics.1 While moderate to severe psoriasis is defined as psoriasis affecting 3% or more body surface area and/or those who are candidates for systemic or phototherapy, patients with genital, nail, or scalp involvement are also considered to have moderate to severe disease.
Psoriasis is a disease that continues to be stigmatized, according to Dr Gelfand. In a study of 198 laypersons and 187 medical students, approximately one-third of responders thought psoriasis was contagious, only affected the skin, and was not a serious disease. Likewise, 39% of responders said they would not shake the hand of a person with psoriasis. Patients with psoriasis are still misunderstood and lack empathy, said Dr Gelfand. Additionally, psoriasis remains undertreated with 60% of patients not receiving treatment in the previous year, added Dr Gelfand.1
“What is great about psoriasis is we have a good understanding of the pathogenesis,” said Dr Gelfand. He often tells patients that normal skin takes about a month to be created while psoriasis is about a day or 2, highlighting the importance of explaining the condition to patients.
The antibody used to treat psoriasis and dose matters, he said, “to treat the disease, you have to know the whole armamentarium.” Therapeutic targets in the treatment of psoriasis include tumor necrosis factor inhibitors, IL-17A and IL-17F, IL-12/23, and IL-23 inhibitors. With the advent of biologics, higher targets for skin clearance are feasible as now more patients are achieving clear or almost clear skin. Dr Gelfand reviewed data on the efficacy of various biologics, including ustekinumab, secukinumab, and ixekinumab. In addition, he discussed the results of a phase 2 trial on bimekizumab, a dual IL-17A and IL-17F, which showed about 60% of participants achieved clear skin.1 Another study, said Dr Gelfand, showed patients who stopped responding to ustekinumab could safely switch to guselkinumab and achieve clear or almost clear skin.
Most adverse events reported with biologics were uncommon, said Dr Gelfand. However, it is important to counsel patients carefully when discussing adverse events, he added.
While data from clinical trials shows high efficacy, “in the real world, people do not respond as we expect,” said Dr Gelfand. Factors, such as patient adherence, obesity, prior and treatment with other biologics or systemic therapies can affect the efficacy of treatment.
Dr Gelfand will discuss cardiovascular disease risk among patients with immune-mediated inflammatory diseases on Sunday, April 7 at 10:30 am.
Reference:
1. Gelfand J. Translating current emerging therapies into enhanced management strategies for psoriasis: A focus on IL-12 and IL-23 pathways. Presented at: 2019 Interdisciplinary Autoimmune Summit; April 5-7, 2019; Chicago, IL.