Emerging Treatment Options for the Management of Moderate to Severe Psoriasis - Episode 4
Dr Jerry Bagel describes the unmet needs of plaque psoriasis management.
Jerry Bagel, MD, MS: How do we go back to the point where [we find] what is being activated, either a dendrite or a keratinocyte that’s activating the whole system? How do we prevent that from happening? I think [another unmet need is] predicting which people respond best to which drug in the beginning. We’re starting to do that now with pharmacogenetics, which would be very helpful. It would be nice to know if a drug worked 70% of the time, well, how can we figure out who that 70% is? Then the other 30% would use something else. I think other unmet needs, even though I say the IL-23s [interleukin-23 inhibitors] are safe, there’s still an increased frequency of nasopharyngitis or upper respiratory tract infections. It would be nice if we could eliminate adverse events completely. It would be nice if we can get people who could be clear, but also I think access, making access easier because not everybody can afford to have their own biologic coordinator. Some offices can’t. They don’t do as much volume, but making access easier for patients would also help.
I think the PASI 90 [90% improvement in the Psoriasis Area and Severity Index] and PASI 100 is what we’re looking at now for most biologics. I think we have somewhat reached a ceiling, although there’s still some room for improvement because even the best biologics give you a PASI 100 of maybe 60%, 62%. So there are still a third of all patients who are not clear.
Transcript edited for clarity.