Novel Topical Treatments in the Management of Plaque Psoriasis - Episode 7

Remittive and Suppressive Therapy in Plaque Psoriasis

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Experts share the difference between the remittive and the suppressive effect in plaque psoriasis and how to get patients there.

Brad Glick, DO, MPH: Linda, explain to me the difference between remittive and suppressive therapy and plaque psoriasis. I’ll extend the questions. Do we have topical therapies in the toolbox that can purport remission? What are some of the data points in clinical trials that are reflective of remission? How do we translate that to clinical practice? Those are a lot of questions, but you can handle them.

Linda Stein Gold, MD:A remittive effect means that we get a patient to the point of disease clearance, and then we’ve put the disease in pretty much a remission. A remittive effect means that when we withdraw therapy, the disease stays at bay. We saw this a little with tazarotene. If we got our patients to almost clear and we removed the tazarotene, some patients maintained effect for up to 4 weeks. That was 1 of the interesting attributes of using tazarotene, which is a very challenging medication to use for plaque psoriasis because of the irritation profile.

A suppressive effect with plaque psoriasis means that we can get that disease under control. By treating as needed or episodically, we can potentially maintain that control. As the disease starts to poke its head up again, we slap it down by adding on that medication again. Remission, or remittive effect, means taking that drug away and potentially modifying the disease so we don’t see signs and symptoms of the psoriasis while they’re off medication. Suppressive means we’re able to keep it at bay with more of an episodic treatment as needed. That’s how I interpret it.

Brad Glick, DO, MPH: We see some of those remittive and even suppressive effects with some of the fixed combination therapies. You nicely described tazarotene, which you talked before about corticosteroids being used in combination with it. We have a couple of agents that are fixed-combination therapies that provide some of that as well. We’ll discuss a little more about remission too. Mona, what are your thoughts on remittive and suppressive effects? What are your optics on that when we’re treating our patients with plaque psoriasis?

Mona Shahriari, MD, FAAD: I completely agree with Linda’s take. When it comes to remittive therapies, when we give them a treatment, even though we tell them this is a chronic disease that’s going to need a chronic treatment, they want to have that hope that 1 day they can stop their topical, stop their oral or injectable, and have a period of time where they don’t need a drug and can maintain that drug-free disease remission. Remittive effect is very important to our patients. A suppressive effect is where we’re able to cool down the disease while we’re using the agent, but when we stop the agent, the disease may come back. Then and we have to knock it back down. From a clinical standpoint, there’s the cost of our biologics, especially some of their potential AEs [adverse effects]. It’s nice to consider taking a patient off a drug, allowing them to have that meaningful remission for a while. If we need to restart the drug, hopefully we can do it safely and recapture some of the efficacy from before.

Linda Stein Gold, MD:For a long time, we’ve had that conversation with our patients: “I got you clear, but I didn’t cure you.” You can’t stop your medication because you’re not cured. You’re just controlled. Now we’re starting to change our conversation a little in a way that to we didn’t expect.

Transcript edited for clarity