Neal Bhatia, MD

GLP-1 receptor agonists show promise for psoriasis and HS, with studies reporting severity reductions of roughly 40% to 80%.

It's still unclear whether this benefit comes from weight loss or a direct anti-inflammatory effect, though early data point to both.

Long-term safety, durability after stopping treatment, and cost remain open questions, making GLP-1s a promising adjunct — not a standalone solution — for now.

GLP-1 receptor agonists, known primarily for their use among individuals with obesity, overweight, and diabetes, are increasingly being explored for their potential role in 

 editorial team spoke with 3 clinicians working in dermatology: Neal Bhatia, MD, the former vice president of the American Academy of Dermatology (AAD), Shanthi Narla, MD, an assistant professor of dermatology at the Medical College of Wisconsin known for her research on the intersection of GLP-1 receptor agonists in dermatology, and Samip Sheth, MD, a dermatology resident and co-author of a recent 

 about their views on this topic, as well as available evidence for GLP-1 implementation and concerns over the use of weight loss drugs for diseases such as psoriasis, hidradenitis suppurativa (HS), and other skin conditions. Their views help to encapsulate the current conversation on GLP-1 use in the dermatology space, with each having presented upon the topic or written about it in their recent publications.

GLP1s in Dermatology: Emerging Evidence and Unanswered Questions

Growing Evidence for Skin Clearance with GLP-1 Use

 paper, his team highlighted psoriasis severity reductions of approximately 40% - 80% when GLP-1s are added to existing drugs or implemented alone in individuals with obesity or type 2 diabetes. A separate trial combining a GLP-1 agonist with an interleukin (IL)-17 inhibitor showed greater levels of skin clearance alongside weight loss. Such findings, he stated, reinforced interest in combination approaches.

Nevertheless, questions remain about the medications’ mechanism. Narla expressed her own view that most existing research has yet to isolate GLP-1 therapy, making it difficult to determine how much of the drugs’ benefits stems from weight loss as opposed to potentially direct anti-inflammatory impacts. In his interview, Sheth described mechanistic data supporting the latter, pointing to GLP-1 receptors’ existence on immune cells and noting that the drugs have been shown to lead to inflammatory marker reductions. Specifically, he highlighted CRP, TNF-alpha, and IL-6.

What Concerns Remain on GLP-1 Use in Dermatology?

Despite the momentum, all 3 of the speakers expressed their own level of cautious optimism. In speaking about concerns related to GLP-1 use, Bhatia warned against unregulated or compounded GLP-1 products and their risks, especially given the seeking of access among patients outside standard prescribing channels. Both Sheth and Narla also flagged disease improvement as potentially reversable if patients on these therapies discontinue their use. 

The dermatologists also pointed to most trials on GLP-1 use in dermatology as spanning only a few months in length, leaving questions related to their long-term safety and durability somewhat unanswered. Access as well as cost were additionally described as key issues faced by patients, with all 3 physicians highlighting concerns related to incosistent insurance coverage depending on one’s indication.

At the present moment, many physicians view GLP-1s as a promising adjunctive tool as opposed to a standalone solution for dermatologic diseases, and the speakers described their view regarding this form of medication as a tool probably requiring collaboration between dermatology, endocrinology, and primary care as the available evidence for its use continues to expand.

Disclosures: Sheth and Narla had no relevant disclosures of note. Bhatia has reported serving as an advisor, consultant, and investigator for AbbVie, Almirall, Arcutis Biotherapeutics, Beiersdorf, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant Sciences, EPI Health, Ferndale, Galderma, Incyte, ISDIN, Johnson & Johnson, La Roche-Posay, LEO Pharma, Lilly, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, and Verrica Pharmaceuticals.

Lal K. GLP1 Agonist Therapy in Dermatology. Presented at the Society of Dermatology Physician Associates (SDPA) Fall Conference, November 5-9, San Antonio, TX.

Bhatia N. Discussing Promising New Findings on GLP-1 Use in Psoriasis Management, With Neal Bhatia, MD. HCPLive. February 26, 2026. Accessed. July 23, 2026. 

https://www.hcplive.com/view/discussing-promising-new-findings-glp-1-use-psoriasis-management-neal-bhatia-md

Lilly's Taltz (ixekizumab) and Zepbound (tirzepatide) used together delivered superior efficacy in first-of-its-kind Phase 3b trial for adults with psoriasis and obesity or overweight. Eli Lilly. February 18, 2026. Accessed February 26, 2026. 

https://investor.lilly.com/news-releases/news-release-details/lillys-taltz-ixekizumab-and-zepbound-tirzepatide-used-together-0

Sheth S, Merola JF, Weber BN, et al. The National Psoriasis Foundation Primer on GLP-1 Receptor Agonists in Psoriasis: A Review. JAMA Dermatol. 2026;162(6):619–630. 

Narla S, Narla RR. JAAD CME Part 2: Clinical Evidence and Safety Considerations for GLP-1 Receptor Agonists in Dermatology. J Am Acad Dermatol. 2026 Feb 14:S0190-9622(26)00241-0. 

Videos

GLP-1 receptor agonists show early promise for psoriasis and HS, but 3 experts urge caution on mechanism, durability, and long-term safety.

GLP-1s in Dermatology: Emerging Evidence and Unanswered Questions

 of a Biologics License Application (BLA) for imsidolimab in generalized pustular psoriasis (GPP) was announced, the 

 editorial team spoke in an interview with a dermatology leader regarding this move’s significance for patients with GPP.

Vanda Pharmaceuticals' investigational interleukin (IL)-36 receptor inhibitor could potentially add to the limited armamentarium of agents implemented within the GPP patient population. The medication is currently under formal review by the agency as a potential addition to the emerging class of IL-36–targeted drugs in the dermatology space.

Neal Bhatia, MD, a dermatologist at Therapeutics Clinical Research whose location served as an investigator site for the development of spesolimab (Spevigo; Boehringer Ingelheim), the first IL-36 receptor inhibitor approved for GPP, spoke in this Q&A interview about this new announcement regarding imsidolimab:

I wanted to ask you a little bit about the FDA’s acceptance of the BLA for imsidolimab and the significance of this move. What might this mean for patients with generalized pustular psoriasis, and how significant would you say it is for clinicians to see another therapy targeting the IL-36 pathway?

 I think it's actually very novel and well-timed. We were an investigator site for the Boehringer Ingelheim drug, which is now spesolimab. That was the first IL-36 to make it to dermatology for us, which was great to have another molecule, which is even better, and adds to the significance. Leo Pharma now brings spesolimab map to the market for us and they've done a good job with that. That being said, Vanda makes good drugs, from what I understand. I think this is another one where the GEMINI trials. 53% of the patients got to clear or almost clear by Week 4.

For many of these patients who suffer in a prison of misdiagnosis or just not having options, it is really some game-changing stuff for them. More importantly, we're understanding how rapidly the disease can be mitigated with the onset of the intravenous dosage. We saw that with the Effisayil 2 trials and the Effisayil 1 trial as well, and it brought them both to relevance. The Effisayil 2 trials, specifically with the SubQ to keep things away…I think what imsidolimab is showing us is that it's got a very similar destiny, if you will. Clinically, thinking about durability, the 2-year maintenance period without flares is a significant improvement from what we know from a patient's quality of life standpoint.

My biggest take home point is that I hear a lot about a lot of dermatologists say, ‘Well, my patients got better with a 17 inhibitor or a 23 inhibitor.’ From a psoriasis pathway, there is always a little bit of overlap. What interleukin-17, what IL-23 does, and what some crossovers like IL-22 are involved with is that they're all intermixed into it. There's going to be a little impact from what targeting those cytokines can do. But GPP is well established in an interleukin-36 milieu, where that cytokine is the main driver. You see a lot of neutrophils and a lot of reactive oxygen species, a lot of tissue damage. All of that is unique to the IL-36 pathway, and by inhibiting that, just like we saw with spesolimab, we'll see that with imsidolimab. We can make real headway in keeping the disease away. Not just making it go away.

You mentioned to the 53% of patients attained clear or almost clear skin by Week 4. How meaningful would you say that level of rapid response is for clinicians managing acute GPP flares?

You can look at it from the dermatologist's side as well as the patient's side. Obviously, from the patient side, if they have had no relief of the pain of the visceral symptoms, the fevers, the misery that they go through with the pustules, this will be a godsend for them. I would say that first and foremost, a lot of these patients just live in fear of their next flare. Even when their flare is put out, the first thing they do is worry about when the next one is. Again, that is the nature of the disorder. I think even more so, to see some quick onset of relief, it should take away the thought process of turning to a 17 inhibitor or 23 inhibitor, when that isn't the pathway of choice, and it's not really what we see under the hood for GPP. With the label of psoriasis under generalized pustular psoriasis, there's going to be a mindset that says, ‘Sure, these psoriasis drugs should work.’ But I think we've seen enough data, as well as seen enough mechanism of action discussion, that we know that the inhibition of the 36 pathway is really the key to success for these patients.

 From a clinical perspective, how important is the reported durability of response over the roughly 2-year maintenance period with flares in the active treatment arm?

If we can put out the flares and give patients some relief of their potential onset, that's a very significant win for how this drug could impact the market. Understanding 2 years [of maintenance] for patients who have had this disease, you can imagine what that does to quality of life. We talk about quality, like for eczema, psoriasis, and other disorders like hidradenitis, and these are all very significant. But from what we've seen of GPP, we haven't had an option that has really been a benefit. We've seen cyclosporine and some of these other Th1 drugs go after that process, which is incomplete. They're slow-acting, and they come with their own baggage. So, to see where we can get some real relief from what the GEMINI trials showed us, as well as what we can see in the 2-year data, I think we have a lot of opportunities to put out fires that didn't get put out before.

 If it is approved by the FDA, where do you think imsidolimab could fit within the current treatment landscape for GPP?

If you look at, you know, spesolimab against the current market-approved treatments, it would probably be side-by-side with that. I would hope that the dermatologists are understanding that that pathway is not the pathway that affects GPP, even though there may be some anecdotal evidence. A lot of dermatologists will say, ‘Oh, sure, my patients do better on 17, 23,’ as I said, and for me, that makes sense, because you have easy access to it. You have easy access to a sample of it to get them started. But if that is the way to get the ball rolling and then get them on an IL-36-modifying treatment, I think that would be a paradigm that would actually make a lot of sense.

Given the rarity and the severity of GPP, how might a therapy with a favorable safety profile and low incidence of anti-drug antibodies influence treatment decision-making in clinical practice?

 I think the first key is just making the diagnosis. Get that diagnosis confirmed. I would give the patient their own path report so that they carry it around in case they run into trouble, or they get into an emergency room or urgent care where they can't get treated. They can show whoever has seen them that this is their diagnosis. I think the other key to the equation, too, is to get them to a place where infusion can be as easy as possible, or at least have access to the drug within a day or 2, to try to get them out of the flare.

Really thinking about the big picture for the dermatologist is being an advocate for these patients, saying, ‘Look, this is a rare disease. This is not just a variant of psoriasis that I can try to knock down with other therapies that I have samples of.’ I think even more so, just to support the research as well as the approval of some of these newer therapies and say, ‘Well, we're going to welcome those into dermatology and not give these away to rheumatologists and oncologists.’ Because that's where we lose our edge on our specialty. That would just be a shame.

The quotes contained in this summary were edited for the purposes of clarity.

Bhatia reported serving as an advisor, consultant, and investigator for AbbVie, Almirall, Arcutis Biotherapeutics, Beiersdorf, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant Sciences, EPI Health, Ferndale, Galderma, Incyte, ISDIN, Johnson & Johnson, La Roche-Posay, LEO Pharma, Lilly, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, and Verrica Pharmaceuticals.

Smith T. FDA Accepts BLA for Imsidolimab as Generalized Pustular Psoriasis Treatment. HCPLive. February 25, 2026. Accessed April 28, 2026. 

https://www.hcplive.com/view/fda-accepts-bla-imsidolimab-generalized-pustular-psoriasis-treatment.

Vanda Pharmaceuticals Announces FDA Acceptance of Biologics License Application Filing for Imsidolimab for the Treatment of Generalized Pustular Psoriasis. Vanda Pharmaceuticals, Inc. February 25, 2026. Accessed April 28, 2026. 

https://www.prnewswire.com/news-releases/vanda-pharmaceuticals-announces-fda-acceptance-of-biologics-license-application-filing-for-imsidolimab-for-the-treatment-of-generalized-pustular-psoriasis-302696991.html

Articles

FDA acceptance of a BLA places imsidolimab, an investigational IL‑36 receptor inhibitor, under review as a second targeted option for generalized pustular psoriasis alongside spesolimab. GEMINI results showed 53% achieving clear/almost clear skin by week 4, supporting rapid control of painful systemic flares. Reported durability with roughly two years of maintenance without flares could meaningfully improve quality of life versus slower, toxic immunosuppressants. Emphasis remains on correct diagnosis, timely infusion access, and prioritizing IL‑36 over IL‑17/23 off‑pathway use in routine practice.

In this Q&A interview, Bhatia discusses the FDA's recent acceptance of BLA for imsidolimab for generalized pustular psoriasis (GPP).

Q&A: Discussing Imsidolimab for Generalized Pustular Psoriasis, With Neal Bhatia, MD

Discussing the Significance of Imsidolimab’s Rate of Response in GPP, With Neal Bhatia, MD

, the potential for 2 flare-free years could represent a fundamental shift in what GPP treatment can offer.

 interview with Neal Bhatia, MD, who reflected on the maintenance data emerging from the GEMINI trials for imsidolimab, Vanda Pharmaceuticals' investigational interleukin (IL)-36 receptor inhibitor currently under 

US Food and Drug Administration (FDA) review

 with a PDUFA target date of December 12, 2026.

"You can imagine what that does to quality of life," Bhatia said of the roughly 2-year maintenance period without flares observed in the active treatment arm. Bhatia contrasted this with the limitations of older systemic options such as cyclosporine, characterizing them as slow-acting and burdened by tolerability concerns. These were considered drugs addressing GPP incompletely. The GEMINI data, in Bhatia’s view, represents a meaningful opportunity to extinguish flares that prior treatment paradigms could not reliably control.

On the question of where imsidolimab could fit within the treatment landscape if approved by FDA officials, Bhatia positioned it alongside spesolimab, the currently approved IL-36 inhibitor for GPP, as a natural companion in that targeted class. He acknowledged the real-world tendency among some clinicians to initiate treatment with IL-17 or IL-23 inhibitors given their accessibility and familiarity, but framed that only as a potential bridge. Getting patients to use an IL-36–modifying therapy, Bhatia expressed, should remain the clinical objective.

The therapy's reported favorable safety profile and low incidence of anti-drug antibody formation also carry practical weight in Bhatia's view, though he highlighted his own view suggesting none of it matters without an accurate diagnosis in hand. He recommended patients carry documentation of their confirmed GPP diagnosis to facilitate appropriate care in emergency or urgent care settings where treating clinicians may be unfamiliar with the condition. Equally important, he stressed, is ensuring these individuals have rapid access to infusion therapy at GPP flare onset.

Bhatia closed with a broader call to action for dermatologists, to advocate for GPP patients, embrace emerging targeted drugs, and resist ceding ground on rare inflammatory skin diseases to other specialties.

“This is a rare disease," Bhatia said. "This is not just a variant of psoriasis that I can try to knock down with other therapies that I have samples of."

The quotes contained in this interview summary were edited for clarity.

Vanda Pharmaceuticals Announces FDA Acceptance of Biologics License Application Filing for Imsidolimab for the Treatment of Generalized Pustular Psoriasis. Vanda Pharmaceuticals, Inc. February 25, 2026. 

Bhatia N. What Is the Significance of New Data on Imsidolimab for GPP? With Neal Bhatia, MD. HCPLive. March 10, 2026. Accessed March 11, 2026. 

https://www.hcplive.com/view/what-the-significance-new-data-imsidolimab-gpp-neal-bhatia-md

This segment of Bhatia's interview highlights imsidolimab's reported durability of response for those with generalized pustular psoriasis (GPP).

What Is the Significance of New Data on Imsidolimab for GPP? With Neal Bhatia, MD

US Food and Drug Administration (FDA)'s acceptance

 of a Biologics License Application (BLA) for imsidolimab, Vanda Pharmaceuticals' investigational interleukin (IL)-36 receptor inhibitor for 

, could represent a meaningful step forward for a patient population with historically limited treatment options. The therapy is now under formal review as a potential addition to the emerging class of IL-36–targeted agents in dermatology.

Neal Bhatia, MD, a dermatologist at Therapeutics Clinical Research whose location served as an investigator site for the development of spesolimab (Spevigo; Boehringer Ingelheim), the first IL-36 receptor inhibitor approved for GPP, referred to the development as "novel and well timed." Having another molecule targeting the same pathway, Bhatia highlighted, only adds clinical relevance.

"…[For] many of these patients who suffer in a prison of misdiagnosis or just not having options, this is really some game-changing stuff for them," Bhatia said.

Central to his enthusiasm are the GEMINI-1 and GEMINI-2 trial results, in which a single intravenous dose of imsidolimab led 53% of treated patients to achieve a Generalized Pustular Psoriasis Physician Global Assessment (GPPPGA) score of 0 or 1, suggesting clear or almost clear skin — by week 4, compared with 13% on placebo. Bhatia emphasized that rapid onset is particularly consequential in GPP, where flares can escalate to life-threatening complications including cardiovascular failure and sepsis.

The durability data may be equally compelling. Patients who continued into a roughly 2-year maintenance phase on monthly dosing experienced no disease flares in the active treatment arm, a finding Bhatia described as a significant quality-of-life advance for patients who, even in remission, live in fear of their next episode.

Bhatia also addressed a persistent clinical misconception: the tendency among some dermatologists to reach for IL-17 or IL-23 inhibitors in GPP given their established efficacy in plaque psoriasis. While cytokine pathway overlap exists, he was direct in distinguishing GPP's pathophysiology.

"…GPP is well established in an interleukin-36 milieu, where that cytokine is the main driver," Bhatia expressed. He pointed to the prominent role of neutrophils, reactive oxygen species, and tissue damage unique to IL-36 dysregulation. Targeting that pathway specifically, as both spesolimab and potentially imsidolimab do, is what Bhatia characterized as the key to not just resolving flares, but keeping the disease away.

Smith T. FDA Accepts BLA for Imsidolimab as Generalized Pustular Psoriasis Treatment. HCPLive. February 25, 2026. Accessed March 10, 2026. 

https://www.hcplive.com/view/fda-accepts-bla-imsidolimab-generalized-pustular-psoriasis-treatment

Vanda Pharmaceuticals Announces FDA Acceptance of Biologics License Application Filing for Imsidolimab for the Treatment of Generalized Pustular Psoriasis. Vanda Pharmaceuticals, Inc. February 25, 2026. Accessed March 10, 2026. 

This interview highlights the significance of the potential FDA approval of imsidolimab for patients with generalized pustular psoriasis (GPP).