Frontline Forum Part 2: Challenges and Opportunities to Enhance Psoriasis Management

Before reading, review part 1 here.

Continued in part 3.

Unique Needs of Patients With Skin of Color

The panel delved into the specific needs of patients with melanin-rich skin and provided valuable insights into optimizing psoriasis care for this patient population. They noted that some patients have expressed distrust in the health care system or experience with clinical trials and may prefer topical treatments over systemic agents.

“When it comes to putting [patients with skin of color] on a systemic agent, a lot of them have distrust in the health care system or experience with clinical trials. They don’t always want to go on a systemic [treatment],” Shahriari said. “They’d rather go on a topical [treatment], and [with] our older-generation special topical corticosteroids, a big concern was hypopigmentation or other pigmentary alterations. In the scalp, the formulations we had weren’t ideal for tightly coiled hairs.”

The panel also discussed the potential risk of hypopigmentation and other pigmentary alterations with older topical corticosteroids and the need for newer formulations. “We want to simplify the treatment regimen. We want to pay attention to skin of color and the hypopigmentation that can come from topical steroids,” Stein Gold explained. “We want to do a more holistic treatment for the patients [with] psoriasis where we can treat short term as well as a long term. It doesn’t mean we won’t use combination therapy with these new topicals, combination with topical steroids or systemic agents, but I think they’re [an] important addition to the treatment arm in this area.”

The panelists highlighted the significance of tailored treatment approaches for patients with melanin-rich skin, with Kircik noting, “When you look at the statistics, there’s so much discordance between the perception of the disease by the provider vs the patient and it doesn’t match.” This insight underscores the need for health care providers to understand and address the unique experiences and perceptions of psoriasis in patients with melanin-rich skin.

Looking at Long-Term Safety and Efficacy

Stein Gold, Shahriari, and Cameron explored emerging oral treatments for the management of plaque psoriasis, emphasizing the novelty of TYK2 inhibition. They discussed the unique POETYK PSO-LTE (NCT04036435) trial design, stressing the importance of the inclusion of an active control arm. Shahriari explained the significance of trials for deucravacitinib (Sotyktu; Bristol Myers Squibb), stating, “We had our POETYK PSO trials, which were the pivotal trials for deucravacitinib. And apremilast, our other oral agent on the market, was the active comparator.”

The POETYK PSO-LTE clinical trial assessed the 3-year results of deucravacitinib treatment in adult patients with moderate to severe plaque psoriasis. The trial included 1519 patients who received at least 1 dose of deucravacitinib across multiple phases.¹

Combining Topicals With Systemic Therapies

Shahriari provided an overview of the evolution of treatments for plaque psoriasis, stating, “After the 2000s, we decided to become more targeted and specific in our treatments for plaque psoriasis, and that’s when the era of the biologics started.” The panel shared insights into the pivotal role of biologic agents in the shift toward more targeted and specific treatments for plaque psoriasis.

Han discussed diversity within the IL-17 family of biologic agents, stating, “What’s interesting to me is that in the IL-17 family, we have so much diversity now: IL-17A inhibitors and IL-17 receptor blockers, a dual IL-17A and IL-17F.” This emphasizes the diversity and ongoing development within the IL-17 family of biologic agents, reflecting the evolving landscape of biologic treatments.

The panel also discussed the considerations for choosing between biologic and small-molecule treatments and treatment duration. Han also mentioned, “I think it makes sense. One of the things that Leon [Kircik] said, to your point of why not just put them on a biologic, with a small-molecule [treatment], you don’t have to worry about the half-life, about how long they keep it on board, about developing antidrug antibodies.”

Kircik emphasized the importance of topical treatments in combination with systemic therapies and said, “I always say that topical treatment is the foundation of dermatologic treatment. No matter what, we have biologics, we have oral treatments, we still use topical treatment for those patients. And we use combination treatment, right? Regardless of what we are doing...oral, systemic, light treatments, I always add topicals. I use biologics in combination with topicals; systemics-topicals; and light treatment- topicals.”

Reference

1. Sotyktu (deucravacitinib) long-term data demonstrate durable efficacy and consistent safety for up to three years in moderate-to- severe plaque psoriasis. News release. Bristol Myers Squibb. October 11, 2023. Accessed January 6, 2024. https://www.businesswire.com/news/home/20231010884695/en/Sotyktu-deucravacitinib-Long-Term-Data-Demonstrate-Durable-Efficacy-and-Consistent-Safety-for-up-to-Three-Years-in-Moderate-to-Severe-Plaque-Psoriasis