Review of Current and Novel Treatment Pathways to Manage Plaque Psoriasis - Episode 13

Challenges in Plaque Psoriasis Treatment Therapy

The panel each list challenges and unmet needs faced when managing the treatment of plaque psoriasis.

Linda F Stein Gold, MD: Another issue that’s important to address is the fact that despite so many great treatment options, we don’t have ultimate success with a lot of patients with psoriasis. I’m going to ask each of you, what are some of the challenges that we’re facing in getting our patients under good control? Jerry, let’s start with you.

Jerry Bagel, MD, MS:The challenge is that person who doesn’t respond to the first treatment, because the one who doesn’t respond to the first treatment, it’s a slippery slope, and they’re probably not going to respond to the second and they might not respond to the third. And then you’re down, we have 11 FDA-approved agents for the treatment of psoriasis, and you get down to No. 5 or 6. And I feel at that time, it’s almost like you’re throwing darts. You’re not sure about the pharmacogenetics of this individual, what are they going to respond to? And as we jump back to the conversation from about an hour ago, OK, do I have to add methotrexate for this patient now? I wanted to get away from methotrexate 20 years ago. The nonresponder is still one of the biggest challenges. The second is noncompliance, people who decide that they don’t want to take medications anymore. The medications are better now. They stay better for longer than they did 10 years ago. But still, it becomes difficult with noncompliance.

Linda F Stein Gold, MD: Yes, I was thinking that as well. Leon, do you feel that noncompliance is a major obstacle, a big hurdle, that our patients are just not doing what we want them to do?

Leon H. Kircik, MD:Noncompliance has become an exaggerated issue. The person who’s going to be noncompliant is going to come to the doctor the first time to seek treatment, but then he or she’s not going to come. People who want treatment, they do come, they do want to get better. The problem is, No. 1, we don’t have an ultimate cure, right? We have 11 biologics, but we don’t have a cure for psoriasis. All we do is control, clear the patient and control. But I think what Jerry brought up is an important issue. What if they don’t respond to the first one or the second one? It’s a slippery slope. However, what we have on the horizon is personalized treatment. There are a lot of companies looking genetically for patients who are going to respond to each class of drug, and that’s coming soon. That’s going to increase compliance. That’s going to increase our credibility in front of the patient, and that’s going to decrease the cost. Can you imagine if the insurance company knows which patient is going to respond to which biologic? They’re going to cover it, there is not going to be switching. Those are the days we are waiting for, and this is what we are looking for. This is the biggest unmet need.

Linda F Stein Gold, MD: Mark, any special challenges that you face?

Mark Lebwohl, MD:Like my colleagues, access is everything. Many of our fellow dermatologists don’t prescribe treatments for psoriasis because they can’t get them. Indeed, they can get them, but they need to figure out how to do it. No. 1 is access. No. 2 is psoriatic arthritis. We are still talking about ACR20s [20% improvement in American College of Rheumatology criteria] and ACR50s; we are not talking about ACR100s ever. We need to get in arthritis to where we are in psoriasis, where we can literally knock out the disease in everyone. That’s where we need to be.

Linda F Stein Gold, MD: That would be great.

Thank you, Mark, Jerry, and Leon, for this rich and informative discussion. Thank you 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 in your inbox.

This transcript has been edited for clarity.