Approaches to Treating Plaque Psoriasis

Opinion
Video

Expert dermatologists share how the understanding of the pathophysiology of plaque psoriasis guides approaches to therapy.

Bruce Strober, MD, PhD, FAAD: So Ben, we have a lot of different biologics now, more so than ever. There are multiple mechanisms of action [MOAs]. Basically, we understand how to approach psoriasis because we understand the pathophysiology. How does the pathophysiology in our understanding of it educate you and your approach to therapy?

Benjamin Lockshin, MD, FAAD: Well, I think the multiple different MOAs, going from IL-17s to IL-23s, TNF[tumor necrosis factor] alphas, 12-23 agents, as well as now a few oral small molecule medications, do afford us the opportunity to pick and choose based on the comorbidities that the individual has. But thinking about what our targets are and having a better understanding of this disease process really allows us to home in on certain patient populations and effectively treat patients with a mechanism of action that we think is most appropriate for them.

Bruce Strober, MD, PhD, FAAD: I think an important point when it comes to mechanism of action is [that] because we’re so targeted, we are able to achieve more efficacy but not pay the price of safety. That’s a broad generalization, but all of us would agree where we are today as opposed to 2 decades ago is a sea change difference, really high levels of clearance in the majority of patients who receive our modern biologics, and at the same time little to no monitoring of these patients from a laboratory standpoint or even other [adverse] effect issues. It’s a very easy approach now that we didn’t have a long time ago. Anything you wanted to add to that, Jennifer?

Jennifer Soung, MD: It’s been so amazing having the tools we now have to treat our plaque psoriasis patients that when I’m using one of our highly effective biologics like an IL-23 and the patient’s not responding, or I get a referral from another dermatologist like, “It didn’t work.” I actually question the diagnosis of psoriasis.

Bruce Strober, MD, PhD, FAAD: That’s an absolutely valid point. In that regard, the mechanisms we employ to treat psoriasis are so predictable that failure makes you question, “Maybe this patient doesn’t have psoriasis, in fact.”

Transcript is AI-generated and edited for clarity and readability.

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