Expert Physician Assistant & Nurse Practitioner Insights on the Management of Plaque Psoriasis from Real-World Data - Episode 10

Considerations When Approaching Treatment for Plaque Psoriasis


Matthew T. Reynolds, PA-C, comments on how evaluating treatment profiles, comorbidities, age, and population can help the clinician understand plaque psoriasis and improve management strategies.

Jayme Heim, MSN, FNP-BC: Let’s talk about those patients with comorbidities and age-related considerations. When we talk about those and you look at that long-term safety data, is there anything that really says to you, “You know what? It takes those concerns I have, and it really lessens those concerns when we look at that long term safety data”?

Matthew T. Reynolds, PA-C: In screening these patients and trying to identify who is sicker or at more risk of having complications, for me, knowing that the data is out there that shows that the [interleukin (IL)-23] class as a whole has to be one of the cleanest medications that you can write for these patients. I’ve even used that data to talk to a patient’s oncologist or talk to a patient’s GI [gastroenterologist] specialist or primary care doctor not only to reassure them that we are keeping the patient’s best interest in mind or keeping their overall health in mind, but we have used that data as almost a guiding point in managing these older patients who are a little bit sicker. We know that a lot of these comorbid conditions coexist with psoriasis, so we use that opportunity as well to counsel patients on managing those diseases because it may affect their overall psoriasis treatment outcomes. We counsel the patient’s primary care provider or their other specialists that treating their psoriasis with these molecules may help treat the other associated inflammatory conditions, their comorbid conditions, and make those easier to treat for these patients. When I talk about this, I always think about those patients who have terrible diabetes or terrible cholesterol numbers. I’ve drawn some of these labs myself and in screening labs, trying to identify who’s at most risk. Again, just having that data and knowing that these patients are going to do quite well and at 5 years and with continual data and long-term extension data that is produced, I expect those studies and I expect that data to show a similar level of assurance that these patients are going to do quite well on this class of drugs.

Jayme Heim, MSN, FNP-BC: We’ve talked about those patients who are over 60 years of age. We’ve talked about patients who have a larger BMI [body mass index], over 25. When we look at the clinical information and the studies that have been done so far, can you identify any other patients who should be investigated for this class of medication?

Matthew T. Reynolds, PA-C: We need to be looking at younger and younger populations for the IL-23 class. Psoriasis can occur at any age. We know that certain children do develop psoriasis at early ages. I think the earliest child that I’ve found with psoriasis that I’ve been able to confirm is 3. Investigating these patients at younger ages is absolutely paramount. We have molecules, we have drugs that we can use right now in this age range, but over time we’re going to find that giving the patients the option of an every 2- or 3-month dosing scheme in the younger patients is going to provide parents with a lot of reassurance. It’s also going to provide those children with a lot of reassurance because their treatments are going to be easier than what we currently have available. For us, we need to continue to identify the true pathway that’s involved with IL-23 and psoriatic arthritis. We need to continue to investigate other comorbid conditions, such as ankylosing spondylitis, as well as the overall role with IL-23 and inflammatory bowel disease and other indications that can follow from that. When I think about that question and new patient populations, the number one thing that I think about is the younger kids who develop psoriasis.

Jayme Heim, MSN, FNP-BC: Thank you, Matt. In regard to that, are there any other populations that we can possibly look at to increase the diversity? Within these clinical trials we often see, especially within psoriasis, the mean age is in their 40s, the population is usually Caucasian. What would you like to see regarding diversity?

Matthew T. Reynolds, PA-C: I think that’s a great question. In our area, we are very fortunate to enroll a high population of darker skin types, so there are more skin types from the Fitzpatrick scale there. As for the African American population, specifically, there are studies that are being specifically designed in skin or color currently, but we need to continue to build our wealth of data in that patient population. We need to continue to investigate also in patients who have special subtypes of psoriasis, such as isolate scalp disease. We need to continue to investigate the male disease component. A specific set of studies for genital data would be wonderful, but the biggest thing that we’re missing from clinical trials data is our minority populations. Having specific studies designated to those groups is going to be essential moving forward as we figure out the IL-23 pathway and its overall role in treatment of plaque psoriasis.

Transcript edited for clarity