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Extrapolating Clinical Data for Decision-Making


Mark Lebwohl, MD, details how he extrapolates clinical data in his decision-making when trying to treat patients with psoriasis.

Ryan Haumschild, PharmD, MS, MBA: Given examples of some of the long-term follow-up or resurface data, at your organization how do you utilize or prioritize this extrapolation of primary literature as part of your decision-making process for your unique patients?

Mark Lebwohl, MD: I will say first of all, if somebody again had squamous cell carcinoma, they’re not going to get a TNF [tumor necrosis factor] blocker. If they’ve had multiple sclerosis, they’re not going to get a TNF blocker. If they’ve had Crohn disease, they’re not going to get an IL-17 [interleukin-17] blocker. In terms of metabolic syndrome and the factors that go into it, the average weight of those patients makes the less effective treatments we have poorer choices for them. It’s the kind of prescription that will almost for sure lead to a switch. Thus, knowing in advance that it’s going to lead to a switch, why would we prescribe those?

On the other hand, if a patient has psoriatic arthritis and inflammatory bowel disease, the best choices for psoriatic arthritis are TNF blockers and IL-17 blockers. There, if they have inflammatory bowel disease, I’m not going to give them an IL-17 blocker. Those patients are very good choices for TNF blockers. You have to take the whole picture into consideration when you figure out which drug you’re going to give to which patient.

This transcript has been edited for clarity.

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