Novel Topical Treatments in the Management of Plaque Psoriasis - Episode 13

The Future of Plaque Psoriasis Treatment

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Brad Glick, DO, MPH; Mona Shahriari, MD, FAAD; Michael Cameron, MD, FAAD; and Linda Stein Gold, MD, comment on the future of plaque psoriasis treatment and share clinical pearls on the management of plaque psoriasis.

Brad Glick, DO, MPH: What are you excited about? What’s up and coming? Linda, what’s coming for patients with plaque psoriasis?

Linda Stein Gold, MD: I’m excited about seeing how well some of our medications do in combination. I’m excited about new molecules. I’m excited about topical therapy. We can’t forget about topical therapy. I’m so thrilled that we have these 2 new nonsteroidal options. I want to make sure we continue research and development in the topical arena because if you have moderate to severe plaque psoriasis, I can do wonderful things for you. Patients who have localized disease can be more challenging to treat. I’m excited to continue to see the research and development and continue to see work on getting us even better treatment. We’ve come so far, but we have a little ways to go.

Brad Glick, DO, MPH: Mona, what’s in your crystal ball? What are you excited about?

Mona Shahriari, MD, FAAD: I have a great interest in treating patients with skin of color who have inflammatory skin disease, in particular psoriasis. Newer dedicated studies of patients with skin of color are underway, and they can potentially change the game. They’re important because patients with skin of color have historically been underrepresented in clinical trials. Whether it was for systemic agents or topical agents, these individuals have unique needs. They may not respond in the same way to our topicals or systemics, and they may have different safety signals that we have to worry about. These newer studies are going to give us insights into the diagnostic and treatment nuances of psoriasis in skin of color. Hopefully, if we learn more about these special considerations, we can allow for our patients to get high-quality care in an inclusive society.

Michael Cameron, MD, FAAD: I’m most excited about these oral biologics. We have several companies potentially bringing to market oral IL-17 and IL-23 inhibitors. The fact that we might finally be able to deliver a protein therapeutic via the GI [gastrointestinal] tract is exciting. It’s crazy to think we can do it, but the early phase 1 and 2 data are compelling, so we’ll see if we can get that through. Janssen and some other companies have those therapies. That’s what I’m most excited about.

Brad Glick, DO, MPH: Mona, tell us some clinical pearls that you have in managing patients with plaque psoriasis. Give us a couple of thoughts about some approaches that you have.

Mona Shahriari, MD, FAAD: The most important thing I try to teach my residents or talk to patients about is that psoriasis goes beyond the skin. That multidimensional burden is key, and it keeps the whole patient in mind. Screen them for comorbidities, ensure that they’re plugged in with a primary care doctor. We’re dermatologists, but we’re also doctors. We have to treat the patient and not dump them on the next specialist. We have to ensure they get comprehensive care, so they can lead better lives.

Brad Glick, DO, MPH: Linda, some pearls from you as we close out.

Linda Stein Gold, MD: One of the most important things I’ve learned is that it’s important to stay up to date on what’s new in terms of treatment options. There’s so much research and development going on. We owe it to ourselves and our patients to understand the new treatment options and not always fall back on traditional medications that we’re comfortable with. We have to get outside our comfort zone and learn the new medications. That way, we’ll be able to choose the right medications.

Michael Cameron, MD, FAAD: That what’s been nice about the dermatology space: this expansion of the dermatology-focused pharmacy. They’re everywhere. They’re not just in Manhattan. Patients think they have to go to the local pharmacy. When you show them that there are dermatology-focused pharmacies that are good at getting tapinarof and roflumilast covered. They see that and then end up getting the therapy. A lot of times, individuals run into issues with these newer topicals because of access, and they have this perception that they’re not going to be able to get their patients the drug. I work with local pharmacies, the ones that are more dermatology focused, to get it. When you say nonsteroidal to a patient, they’ll do whatever it takes to get it. Patients don’t want to use steroids. That’s my experience. Lastly, another perception about branded topicals is the cost to the health care system. Let me assure you, clobetasol is not cheap. There are only a few manufacturers of clobetasol ointment in the country. You can look up the cost. It’s not much cheaper than these branded nonsteroidals. Those are just a few pearls.

Brad Glick, DO, MPH: Linda, Mona, and Michael, thank you for a great experience discussing topical treatments for patients with psoriatic disease. It was really enjoyable. I’ve had a great opportunity to interview a number of individuals, and this was a rewarding experience. Thank you to the 3 of you.

Linda Stein Gold, MD: Thank you. It was wonderful.

Mona Shahriari, MD, FAAD: Thank you, Brad.

Michael Cameron, MD, FAAD: Thanks for having us.

Brad Glick, DO, MPH: Thanks to all of you for this rich and informative discussion. Thank you all for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right to your in-box.

Transcript edited for clarity