Anthony M. Turkiewicz, MD: Let’s move on and go to the dermatology side and discuss factors we consider when choosing 1 biologic or advanced therapy class over another in your psoriasis treatment paradigm? Can you comment on that?
Steven R. Feldman, MD, PhD: The major things I’m considering are safety, efficacy, and what’s feasible for the patient to get. The slight infection risk that you see with TNF [tumor necrosis factor] inhibitors is a reason for me to choose other medications. That uncommon inflammatory bowel disease, exacerbation or new onset with IL-17 blockers makes me lean away from those toward IL-23 blocking drugs. But if the insurer says, “You prescribe whatever you want, but we cover only this particular TNF inhibitor at this point,” then the patient and I will probably choose for them to take that.
Patients’ previous experience with particular classes affects my decision. If they did really well—safety and efficacy were there on a particular class—but that drug eventually stopped working, I may choose another drug from that class for them again. Patient preference is huge, but it’s gotten to the point that there are so many options that the patients can’t choose and they’re relying on me. It’s like the studies that have been done about giving people too many jelly choices in the grocery store; they can’t choose.
This idea of the pill is really fascinating because some patients do come in who saw an ad on television for a pill, so they ask about it. Or if they’ve never been on an injection before, they’re afraid of injections. One way I could get over that is to let them know the medication, “I’ve got a great drug for you that’s very safe, very effective, but it’s given by injection like diabetics take insulin. You know how patients take insulin 2 to 4 times a day? Well, it’s not exactly like insulin, you only have to take it once a month.” If I start by telling patients it’s an injection once a month, their brain compares once a month with not taking an injection, and they don’t want to do it. If I somehow first anchor them on the idea of injections daily or twice a day, then when I tell them it’s once a week, or 1 a month, or every 3 months, they don’t mind nearly as much.
Anthony M. Turkiewicz, MD: That’s very helpful advice. Patient preference can play such a role. And it’s a unique situation that we have a number of therapies, albeit with insurance playing a role in those decisions. But it’s helpful that we have these in our armamentarium.
Transcript Edited for Clarity