Future Directions in the Treatment of Plaque Psoriasis


Key opinion leaders conclude their discussion on plaque psoriasis by commenting on the potential for research into the genetic origin of disease, possible biomarkers, and treatment options with greater efficacy.


Brad Glick, DO, MPH: Let’s segue into our final section, looking at the future and at the psoriasis treatment landscape. George, how do you see it evolving? I want to go around the horn as we wrap everything up.

George Han, MD, PhD: There’s a lot of great research. We already hit on comorbidities and how we’re able to impact that and the genetics. We have a better understanding of what underlies the development of psoriasis with the idea that that could lead us to a cure, potentially. We have a better understanding, perhaps the genesis. There’s other stuff, like biomarkers. How do we rationally select an appropriate treatment for the right patient? For some things, if you could take a noninvasive test or a biopsy and figure out why—“This patient’s specific immune profile favors treatment with this”—that would be a nice benefit.

Lastly, even though we’ve a lot of medicines, we all have patients who aren’t doing well who could use better treatments. We need more efficacious treatments. We talked a little about the new IL-17AF inhibitor. That’s on the horizon and has been a leader of the pack in efficacy numbers. That’s 1 thing we’re looking for. Regarding oral medicines, Dr Bhatia mentioned the TYK2 [tyrosine kinase 2] inhibitor. That’s another thing we’re looking at in an oral medicine that has around a 60% PASI [Psoriasis Area and Severity Index] 75. There’s promise of a more efficacious oral treatment. We just need a better portfolio to be able to give our patients and be able to more selectively manage their disease process in an individualized pattern. That will be the promise going forward.

Brad Glick, DO, MPH: Neal, what are your observations and comments about the landscape for psoriatic disease, moving forward?

Neal Bhatia, MD: George brought up the big 1: the role of tyrosine kinase 2 inhibition, and what we’ve explored, because there’s a big affinity for the processing of interleukin-12 and -23 through that pathway when combined with JAK2, for example. The other part of the equation is that we’re seeing safety signals we’re learning a lot from with 5-year data from the biologic set. Again, show us reliability. The tyrosine kinase pathway for psoriasis will be the big 1 that’s next. Obviously, bimekizumab is the other big biologic on the market in the future. We’ll see where and if that holds up, and then there are a couple of others in development. The future is bright if we decide to use these drugs.

Brad Glick, DO, MPH: Dr Boh, your final comments. What do you think about the future for our patients with psoriasis? What about the treatment landscape?

Erin Boh, MD, PhD, FAAD: What I would like to see is personalized treatment plans. We can achieve that 1 day by going to go back to genetics. It’s all in the genetics. If we can get biomarkers or get micro-assays that say, “This individual has a polymorphism in this gene, so most likely this drug will be your best bet,” then it will be very cost effective and patients will happy. It’s cost effective because we don’t go through 4 drugs to get the 1 that’s going to work for that patient. As we’ve developed, we’ve broken the human genome, and we should be able to figure out, on an individual basis, what that patient’s genetic makeup is in the sense of either messenger RNA sequencing or something where we can we say, “Here’s the defect. Give us the drug.” You’ll save a lot of money. You have a lot of issues solved in terms of expense and treatment. People will be happy. I’m going for personalized medicine, finding the genetic breakdown in each individual. From our great drugs, we can then pick because we have an array of drugs to choose from.

Brad Glick, DO, MPH: There’s no question that we have a remarkable toolbox, and there’s more coming. I want to thank you all for this rich and informative discussion, and thank our viewers for watching this HCP Live® Peer Exchange. If you’ve enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box. Thank you, everyone.

Transcript edited for clarity.

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