How has testing and diagnosis changed?
In an interview with MD Magazine®, Brad Glick, DO, a dermatologist and principal investigator with GSI Clinical Research, explained how psoriasis presents different patient-by-patient, and how such factors and trait influence the improved screening process for the dermatologic condition.
MD Mag: What are the biggest drives of patient-to-patient disparity in psoriasis?
Glick: Various patients will come in, and they will have a typical background of inflammatory bowel disease. And inflammatory bowel disease does occur with some reasonable frequency in the background of psoriasis. We know that patients with inflammatory bowel disease who have psoriasis, their skin disease may predate their inflammatory bowel disease by a number of years.
We have agents that are particularly tailored to those inflammatory mediators: tumor necrosis factor-alpha, interleukin 12, and interleukin 23, that are not only active in the setting of autoinflammatory psoriasis but also in inflammatory bowel disease. That is an example of tailoring treatment to an individual who has a background co-morbidity that needs to be considered and managed.
And that's why we have to ask our patients the right questions when we're assessing them. It's very different than twenty years ago. It's not just a skin disease, it's a systemic disease.
MD Mag: What is the screening process for psoriasis?
Glick: You know, the screening process is big. When I started practicing 24 years ago, you go in a room, you look at a patient who has psoriasis, you see their skin disease. You might look at their medication profile—you might have been thinking it as a systemic disease, but the prescription went for the topical therapy, and out went the patient.
Certainly, we had some of the traditional systemic therapies like methotrexate which we would consider accordingly. But the mindset was different because we've learned so much—not only on the immunological system side of it all, but also about the associated comorbid conditions.
Our questions need to be significant. They're based on background comorbid processes, like hypertension, which is part of the medical metabolic syndrome. As I mentioned before, inflammatory bowel disease.
We have to look at patients, because we are targeting the immune system, we have to make sure that they don't have histories of infections. There are limitations to certain biologic therapies. As an example, patients that have demyelinating diseases like multiple sclerosis. There are not appropriate candidates for tumor necrosis factor inhibitors.
So there are a series of questions that we need to ask, and many of them are based on the patient's comorbid associated conditions. So of course, we have to also ask the psychosocial questions too—the impact on their quality of life, what their occupation is. Some of the agents we have now are injected just 4 times a year. That's quite beneficial for someone who's on a plane every week when they can’t take their agents with them.
So those are some of the questions and the scenarios that I think that we face. But they allow us indeed to be precise because of the drugs that we have today.