Psoriasis and Biologics: Selecting the Right Biologic for the Right Patient

During the first afternoon lecture, Zelma Chiesa Fuxench, MD, MSCE, an assistant professor of dermatology at the University of Pennsylvania, reviewed the currently available biologic agents for psoriasis and how to select the “right” biologic for the “right” patient. She began the lecture reiterating that using the same biologic for all patients is not the right approach. After reviewing the typical presentation of psoriasis as a multisystem inflammatory disorder with a relapsing course and a negative impact on quality of life,  Dr. Fuxench discussed the current assessment tools for psoriasis. She reported currently available treatment options can result in skin clearance or near skin clearance as a realistic outcome regardless of the patient’s baseline disease severity.

Coverage: SDPA 19th Annual Fall Dermatology Conference in Los Angeles Nov. 4-7, 2021

TNF-alpha inhibitors for psoriasis were elucidated by Dr. Fuxench with delivery methods including subcutaneous injections and IV infusion. Dr. Fuxench reports her experience has shown that if a patient fails one TNF-alpha inhibitor, this does not necessarily preclude them from trying other ones.  For example, non-responders to etanercept have been found to be responsive to certolizumab pegol.  Both common and rare severe opportunistic infections were reviewed.

The interleukin-17 inhibitors were discussed next. These medications are injected and the most prevalent adverse reactions include infections, nasopharyngitis, headache and injection site reactions. Dr. Fuxench reviewed how IL-17 inhibitors compare to other biologic treatments. Of note, ixekizumab had greater efficacy compared to placebo and etanercept over 12 weeks of use.  The literature currently reveals overall there are no clinically significant differences between the IL-17 medications with higher adherence rates among patients who use ixekizumab compared to patients on secukinumab. Dr. Fuxench went on to discuss the rates of candida infections in patients who are using IL-17 medications and increased incidence of depression among patients who use brodalumab.

Dr. Fuxench reviewed Interleukin-12/23 inhibitors for the treatment of psoriasis. While still an area of ongoing study, a certain subset of patients have an increased risk or acute coronary syndrome or stroke when they initiate treatment with ustekinumab.  Comorbidities including psoriatic arthritis amongst psoriasis patients were discussed with consideration of selecting systemic psoriasis treatments. Finally, Dr. Fuxench highlighted the important data regarding mental health and suicidality amongst psoriasis patients.

Pictured: Zelma Chiesa Fuxench, MD, MSCE

Byline: Sarah B. W. Patton, PA-C