James Song, MD

Dosing Interval Differences in Psoriasis and Psoriatic Arthritis Treatment

Video content above is prompted by the following:

SPECTREM was the first randomized controlled trial to evaluate biologics in this patient population. What other clinical trial data are there on the use of biologics for difficult-to-treat areas?

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Panelists discuss how although SPECTREM was groundbreaking as the first randomized controlled trial specifically targeting moderate psoriasis in high-impact areas, other valuable evidence exists including subgroup analyses from pivotal trials of interleukin-17 inhibitors (secukinumab, ixekizumab, brodalumab) showing efficacy for scalp and nail psoriasis, dedicated studies like GESTURE (secukinumab for palmoplantar psoriasis), IXORA-Q (ixekizumab for genital psoriasis), data on TNF inhibitors for inverse/intertriginous disease, and observational real-world evidence supporting various biologics for difficult-to-treat locations—though most preceding studies were limited by focusing on patients with higher overall body surface area rather than the clinically important population with limited but high-impact disease that SPECTREM specifically addressed.

Examining the Relationship Between Psoriasis and Psoriatic Arthritis

a.	A high proportion of patients were able to achieve complete skin clearance (IGA 0) across all special sites at week 16 (Glick, 2024).
i.	Scalp 60% vs placebo 9%
ii.	Face 76% vs placebo 24%
iii.	Intertriginous 77% vs placebo 24%
iv.	Genital 73% vs placebo 33%
b.	No new safety signals identified.

Panelists discuss how the SPECTREM trial (Glick, 2024) revealed guselkumab’s exceptional site-specific efficacy for psoriasis in traditionally difficult-to-treat areas, achieving complete clearance (Investigator’s Global Assessment [IGA] 0) in remarkably high proportions of patients compared with placebo—with 60% clearance in scalp (vs 9% for placebo), 76% in facial sites (vs 24%), 77% in intertriginous areas (vs 24%), and 73% in genital regions (vs 33%)—while maintaining a favorable safety profile without new signals, demonstrating the biologic’s particular value for patients with limited but high-impact disease in these psychologically and functionally significant locations.

Key Takeaways on the Role of Oral JAK Inhibitors in Atopic Dermatitis Management

What are some key takeaways or advice for other dermatologists treating patients with atopic dermatitis with JAK inhibitors?

Experts discuss key takeaways for dermatologists managing atopic dermatitis with JAK inhibitors, emphasizing the importance of individualized treatment plans, monitoring for safety and efficacy, and balancing the benefits of JAK inhibitors with potential risks, especially in long-term use.

Oral JAK Inhibitor Dose Escalation in Atopic Dermatitis Treatment

With JAK inhibitor therapy, the dose can be increased if needed based on clinical judgment. How do you decide when a patient should increase the dose of their JAK inhibitor?

How often do you increase to the higher dose of JAK inhibitors in practice?

Experts discuss how clinical judgment guides the decision to increase the dose of a JAK inhibitor, considering factors like patient response and symptom severity, and how often dose escalation is implemented in practice based on individual patient needs.

James Song, MD

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