From Tunnels to Treatment: Advancing HS Management - Episode 8
HS Treatment Access Gaps and the Emerging Therapeutic Pipeline
Insurance and formulary disruptions force difficult interim choices for patients with HS. The panel also shares enthusiasm for emerging mechanisms and the prospect of matching therapies to disease phenotypes.
"HS Treatment Access Gaps and the Emerging Therapeutic Pipeline" takes up the question of how to keep patients protected when access falters and where the field is heading.
The discussion raises a common problem: patients lose insurance, change plans, or face formulary changes. The panel considers whether treatment interruptions require discontinuing a drug or whether patients can restart. One panelist describes practicing in a free clinic, a Veterans Affairs hospital, and an academic health sciences center, as well as the only practice in about 300 miles accepting Medicaid, so interruptions occur often. Many manufacturers offer patient assistance programs that help patients stay on therapy. If a patient falls out of the available safety net and cannot access an advanced therapeutic, clinicians must pivot to older agents to bridge the gap until a more effective and safer option is available. These drugs are less safe and less effective, but described as better than nothing. Commercial payer interruptions, such as job loss or layoffs, create similar problems. Older DMARDs can help temporize. They are not safe for long-term use, but they are acceptable for short-term transitions until patient assistance, bridge programs, or a newer biologic takes over.
The panel then looks ahead to emerging therapies, including JAK inhibitors, BTK inhibitors, IL-1 beta inhibitors, and others in the pipeline. The panel expresses broad enthusiasm for the increasingly granular science. Patients have waited far too long, and knowing that other options exist if one fails helps them feel empowered. The panel anticipates that clinicians will eventually separate patients into groups such as tunnel formation, nodular flare, and pro-inflammatory versus structural disease, then choose the best agent for each. Examples include considering an IL-36 inhibitor for tunnels and BTK inhibitors for the neutrophil microenvironment. The panel notes there are several theories about phenotypes, including follicular-centric disease and acne conglobata types, and expects to learn more as these agents reach clinical use.
The next episode in this series, "HS Care Priorities: Patient-Reported Outcomes, Trust, and Stigma," features the panel closing with the single change they would ask clinicians to make.
