Expert Perspectives on the Management of Plaque Psoriasis - Episode 2
Dr. Jerry Bagel and physician assistant, Alexa Hetzel, comment on the burden of plaque psoriasis and what options are available for the treatment of plaque psoriasis.
Jerry Bagel, MD, MS: For the next section, we’re going to get into the treatment consideration and selection in plaque psoriasis. What are some of the challenges you face when managing plaque psoriasis? Could you provide a brief overview of the burden of plaque psoriasis care that we have on health care providers and patients and their caregivers? In what ways are they similar and different?
Alexa Hetzel, MS, PA-C: The biggest thing that I run into is patients think that psoriasis is just a skin issue, so we have to educate them that psoriasis is a systemic condition. I had a patient come in, and I was talking about psoriasis. She was like, “I have a family history of strokes, and going on a biologic is too dangerous for me.” I said, “You’re more at risk of having a stroke without this biologic medication.” If we let these patients go unmanaged, it puts a burden on our medical society from metabolic disease. These patients have chronic issues with that, like high blood pressure. We’re adding to their insurance needs, and they’re at higher risk for a lot of these other, more dangerous comorbidities.
Jerry Bagel, MD, MS: One thing that’s a challenge, especially with younger individuals, is compliance. People often ask me, if I’m going to put them on a biologic agent, “How long am I going to be on this drug?” It happens all the time. I tell them, “Psoriasis is not poison ivy. This is not a 3-week disease. You have a chronic immunologic disease of your skin that is, unfortunately, going to last forever. You’re probably going to be treated accordingly because once you stop, those genes are going to continue to express psoriatic inflammation.”
Alexa Hetzel, MS, PA-C: Then you worry about antibody development.
Jerry Bagel, MD, MS: If you start and stop, that’s true. It is very likely when you take biologic treatments that you start developing more antibodies. It becomes more of a vaccine than a treatment. What is the impact of the treatment mode of delivery on patient adherence and treatment selection?
Alexa Hetzel, MS, PA-C: As we’ve developed more biologics, not only have we gotten smarter about the safety of it, but there’s less of a need for patients to do things. They used to do injections every week, or every other week, or even infusions. Tar baths were an option. Now patients can get an injection every 12 weeks. That’s way more easy to adhere to than trying to remember to inject yourself once a week or not wanting to inject yourself.
Jerry Bagel, MD, MS: Which do you think is easier: taking a pill every day or a shot every 12 weeks?
Alexa Hetzel, MS, PA-C: If it was up to me, I’d would say to take a shot every 12 weeks. But you have women in my category who also take a pill every day because they take birth control, so it’s based on what patients want. Do we have patients coming in all the time who ask for a pill because it’s an easier option and goes with their high blood pressure medicine, diabetes medicine, or daily multivitamin? Some people are very good at being compliant.
Jerry Bagel, MD, MS: With new oral effective medications coming out, people have the options of taking a pill every day or a shot. The people who clear on psoriasis 4 times with 4 shots a year don’t have to think about their psoriasis for 361 days of the year. They’re doing pretty well. Most of them have certain comorbidities, so they’re taking other pills. Is it a big deal to take another pill? Probably not.
Alexa Hetzel, MS, PA-C: Probably not.
Transcript Edited for Clarity