How to Choose Biologic, Oral Therapies in Psoriatic Disease: Philip Mease, MD

Selecting therapy for psoriatic disease requires a patient-centered approach that balances safety, efficacy, and lifestyle considerations. At the 2026 Maui Derm Annual Meeting, Philip Mease, MD, director of rheumatology and research at the Providence Swedish Medical Center and clinical professor at the University of Washington, emphasizes the importance of clearly explaining medication safety using evidence from large clinical trials, which monitor risks such as infection and malignancy.

Disease manifestations also shape treatment decisions. In patients with prominent axial or spinal involvement, proven efficacy in the spine becomes a critical factor. Because data from ongoing studies—such as the STAR (NCT04929210) trial evaluating guselkumab—are still emerging, clinicians often favor agents with established effectiveness in axial disease, including tumor necrosis factor inhibitors or IL-17 inhibitors.

Lifestyle and treatment logistics play a major role in adherence and satisfaction. Route and dosing frequency should align with patients’ daily routines and travel demands. Individuals who travel frequently or maintain busy schedules may find weekly refrigerated injections burdensome and prefer therapies administered less often, such as IL-23 inhibitors given every 2 to 3 months or IL-17 inhibitors dosed monthly.

Mease also revisits the historical use of methotrexate, noting its potential hepatotoxicity. Patients who regularly consume alcohol may view methotrexate as incompatible with their lifestyle and opt for alternative therapies.

Overall, Mease underscores shared decision-making as the cornerstone of psoriatic disease management. By integrating safety considerations, domain-specific efficacy, and real-world lifestyle factors, clinicians can tailor therapy choices to align with patient preferences and optimize long-term outcomes.