Paradigm Shifts in the Management of Plaque Psoriasis: Advanced Practice Provider Perspectives - Episode 7

Plaque Psoriasis: Transition From Topical to Oral Therapy

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Matthew Brunner, MHS, PA-C, DFAAPA, and Lakshi Aldredge, MSN, ANP-BC, DCNP, discuss factors leading to transition from topical agents to oral systemic therapies for plaque psoriasis.


Lakshi Aldredge, MSN, ANP-BC, DCNP: Matt, do you have any additions about how you counsel your patients or make decisions about moving from topicals to orals? Also, when do you know that an oral medication is not enough, and when are you making the change to, perhaps, a biologic agent?

Matthew Brunner, MHS, PA-C, DFAAPA: Obviously, it doesn't take long to realize that the patient's not responding to topicals. Other patients who come in may be more experienced. If they've been on a class I or II corticosteroid, and they're looking for something else, I'm much quicker to have that conversation with them during that first patient encounter. But I always like to discuss what the next step is if they're not responding, because I want to give those patients hope that there are other therapies, that there are next steps to take. A lot of patients who are reluctant to consider systemic agents are more open to going on oral agents, because it's something they're more familiar with. Taking medicine by mouth is a more typical way that they've experienced medicine in the past, and those patients may be more amenable to trying an oral agent before they jump into receiving an injectable agent.

Again, each patient is very individual. You have to approach patients from their life experience and their comfort level. I really enjoy having that conversation with the patient, because I learn a lot about them, and sometimes there's a little bit of phobias that you have to overcome around medications. I like to ask them, “What are you concerns? What are your questions? What are your hesitations?” because that helps you probe deeper into their reason for not initiating therapy.

Sometimes you can see patients, spend a lot of time counseling about an agent, and make that decision to move forward. Then they never actually start the medication or even pick up the prescription, because they have some unanswered questions. I try to make sure to elucidate those concerns as [we select] therapy together. And that kind of transitions whether patients are good for oral agents or some of the newer biologic agents, like the biologics.

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Transcript edited for clarity.