Expert Perspectives on the Management of Plaque Psoriasis - Episode 4

Experience with Biologics Treating Plaque Psoriasis

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Jerry Bagel, MD, MS, and Alexa Hetzel, MS, PA-C, discuss their experiences with biologics used to treat plaque psoriasis.

Jerry Bagel, MD, MS: As far as my experience with biologics, the concerns, and contraindications inherent to the use of biologics, the IL-23 inhibitors are extremely safe and effective with Skyrizi, Tremfya, and Ilumya being in that group. The first 2 are FDA approved for psoriatic arthritis, but Ilumya also has the benefit that they’ve done some research. Looking at people who take it with comorbidities, like older adults, the safety profile is the same in that group as with under 65. There’s a real safety benefit, but that whole group has changed the complexion of treatment of psoriasis because more health care providers feel safer with that group than even the IL-17s, which work well but still have some risks of inflammatory bowel disease.

Because Crohn disease is a comorbidity of psoriasis, you don’t want to go down that path if you don’t have to. I don’t know necessarily if comorbidities make us more difficult utilizing biologic agents. I do know that obese people tend to have less of a response than nonobese people, which tends to be a factor. Patients with uncontrolled diabetes are susceptible to infections, so they’re a riskier proposition.

Alexa Hetzel, MS, PA-C: You also have to think that we’ve gotten a little more focused. It’s become a cone with the TNFs [tumor necrosis factors] at the bottom of the base, and we’ve gotten more specific and more effective. With Stelara, we used to see that they had 2 dosing for weight-based treatment. Now there are studies with the IL-23s that show patients who are obese or overweight have as good of a response, so it’s nice to be able to not have to dose adjust for those patients. It’s going to work.

Jerry Bagel, MD, MS: Interesting. I just found out that we had done the studies with secukinumab, or Cosentyx, on increasing frequency every other week for the obese individuals. The FDA didn’t approve it. The biologics that are more advanced are working pretty well for obese people compared with if you step down from Enbrel 2 shots a week to 1 shot a week; the obese people weren’t doing very well at all.

Transcript Edited for Clarity