Mona Shahriari, MD, FAAD

Experts conclude the series discussing how to approach switching psoriasis treatments.

When to Switch a Drug Class in Psoriasis Treatment

Dermatologists discuss their approach to managing patients who have experienced treatment failure. They debate whether to switch to a different class of drug or remain within the same class based on factors such as primary versus secondary failure and individual patient response. They also mention specific drugs within the class, like bimekizumab, and discuss the efficacy and considerations of different options. The conversation highlights the complexity of decision-making in dermatology regarding treatment selection for patients who have not responded to TNF blockers.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

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Experts discuss package warnings associated with bimekizumab and how they inform patients of them.

Warnings and Precautions for Newer Psoriasis Treatments

Regarding the warnings in the bimekizumab package insert, specifically about suicidal ideation and elevated liver enzymes, different approaches are taken by physicians in discussing these potential side effects with patients, but each aim to address those concerns with their patients.

Regarding suicidal ideation, some physicians proactively address it with patients, discussing the very rare occurrence of suicidal behavior observed in clinical trials in order for complete transparency. They may reassure patients that no causal association has been established and encourage open communication if any changes in mood or symptoms are noticed. Others may not explicitly mention this warning but address the broader impact of psoriasis on mental health, even directly asking patients about their mental wellbeing, and encouraging patients to report any concerns.

Concerning elevated liver enzymes, physicians acknowledge the recommendation for monitoring but may customize the frequency based on individual patient factors such as comorbidities and suspicion of liver disease. They emphasize the need for initial screening before treatment initiation and potentially more frequent monitoring in high-risk patients. Despite the warning, physicians highlight that elevations in liver enzymes are typically mild and manageable, often related to factors such as fatty liver or alcohol consumption.

Experts discuss bimekizumab for the treatment of psoriasis highlighting is efficacy over other treatments.

Exploring Innovation: Recent Approvals and Novel Approaches to Psoriasis Treatment

Bimekizumab, a newly approved biologic for psoriasis, differs from existing biologics in that it blocks both IL-17A and IL-17F. This dual mechanism of action distinguishes it from previous IL-17 blockers, which targeted IL-17A alone. Clinical trials comparing bimekizumab to other biologics demonstrated superior efficacy in achieving complete clearance (PASI-100) and faster onset of response (PASI-75 at week four). In terms of side effects, bimekizumab, like other IL-17 blockers, may cause oral candidiasis. However, most cases are mild to moderate and manageable with treatment. Patients typically tolerate the medication well, and candidiasis rarely leads to discontinuation of treatment. While clinical trial patients may differ from real-world patients in terms of comorbidities, real-world experiences have shown that patients often prioritize the benefits of bimekizumab over the inconvenience of managing candidiasis.

Experts discuss the warnings regarding IL-17 blockers and inflammatory bowel disease.

Understanding Biologics for Patients With IBD

In discussing the issue of inflammatory bowel disease (IBD) in patients receiving IL-17 blockers, the experts acknowledge the cautionary language in package inserts based on early studies. While there was initial concern about potential exacerbation of IBD with IL-17 blockers, subsequent real-world data have not shown increased or worsened IBD symptoms. Their approach to managing patients with a history of or suspected IBD involves thorough screening, including personal and family history, and symptoms such as bloody stools or nocturnal bowel movements. They also highlight the importance of distinguishing between irritable bowel syndrome (IBS) and IBD, as patients may confuse the two.

Despite the low prevalence of IBD in psoriasis patients and the relatively rare occurrence of IBD exacerbation with IL-17 blockers, the dermatologists exercise caution, particularly in patients with a confirmed diagnosis of IBD. They may avoid prescribing IL-17 blockers in such cases or closely monitor patients with a family history of Crohn's disease. While acknowledging the rarity of IBD exacerbation with IL-17 blockers, the experts prioritize patient safety and consider alternative biologic options for individuals with a history of or increased risk for IBD, including TNF blockers or other targeted therapies. Their approach reflects a balanced assessment of available evidence and individual patient factors to optimize treatment outcomes while minimizing potential risks.

Mona Shahriari, MD, FAAD

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