Balancing Efficacy, Safety, and Lifestyle in Psoriasis Therapy: Steven Daveluy, MD

When selecting a systemic therapy, balancing clinical efficacy, safety, and a patient’s lifestyle is key to long-term treatment success, says Steven Daveluy, MD, dermatologist, Wayne State University.

This transcript was lightly edited; captions were auto-generated.

Transcript

When selecting a systemic therapy, how do you balance efficacy, safety, and patient lifestyle factors to create the best-fit treatment plan?

I'm a really big advocate for shared decision-making, and that's kind of the key to shared decision-making. I'm going to, as the dermatologist, tell you about the efficacy of the drug, how well it works, the side effect profile, and maybe things that will influence our decision in terms of the science, and then the patient needs to share with me what matters in their life. Do they travel a lot, so they can't have something that needs to be refrigerated and with frequent dosing? Are they nervous about needles or needle-phobic? Do they have issues with travel that might impact their ability to come to the clinic and do phototherapy? Bringing all those things together helps us. I'm the expert in your skin and the treatments, but the patient's really the expert in their life and [knows] what's going to work for them. When you bring those together, you get the best outcomes. We literally have research that shows patients can stick to their treatments better when you take the time to make sure it fits their lifestyle as well as how they feel about side effects and safety data, and have that conversation and make sure that you're really hearing the patient and letting them contribute.

What factors most often disrupt patient adherence to systemic therapies, and what strategies have you found most effective for keeping patients engaged?

I would say, in my practice and most of the derms I talked to, the biggest disruptor for patients being able to stay on their medications is logistical issues like their insurance changing what they cover, or a lapse in their insurance, and then they don't have coverage and they're due for a dose, or some other change at the pharmacy that gets in the way. And of course, these are the biggest headaches for not only the patients but the doctors as well, because we get frustrated with all the extra time and effort it takes to navigate the systems.

We have a few things in place in our practice. One is, I try to inform patients if they have any sort of insurance instability where maybe they lose it for a while to let us know, because we can often give them samples of the medications to get them through, so they don't have to go without and then flare up. They also can communicate with our office if they hear from their insurance that they have issues. We have some staff who have gotten very good at navigating these issues and communicating with the pharmacy and with the insurance, but it's still a hassle, and stuff still falls through the cracks. And I'm hopeful that, as our technology is getting better, maybe this is somewhere that something like artificial intelligence or another technology can help us to monitor what patients are on and if they're getting their medication, because we don't have time to check every time someone's due for their dose. Oh, did they get their medication? Did they successfully stay on it? That would take all day for all the patients we have. But technology can actually do that and give us little warnings. I'm hopeful for the future.