Improving Treatment for Psoriasis Across All Skin Phenotypes

Bruce Sherman, MD, FCCP, FACOEM, explores how to improve treatment for psoriasis and education surrounding diagnosing psoriasis for all skin phototypes.

Ryan Haumschild, PharmD, MS, MBA: Biologic therapies have transformed the way we’re treating these patients and provide really good response rates. Dr Sherman, I know that that’s not the case for everybody. There was a study published in 2015 that found the odds of receiving biologic therapy was 69% lower in Black patients compared with White patients. In your opinion, why is that? How can we improve the treatment of psoriasis for all skin phototypes and improve the education of diagnosing psoriasis?

Bruce Sherman, MD, FCCP, FACOEM: That’s a great question. We’ve been in the midst of some more recent research looking at the commercially insured population, and we’re appreciating similar findings for African American and Hispanic individuals, for whom the use of biologics is substantially lower than it is for White individuals. What’s intriguing about the data is that the findings are most exaggerated in lower-income categories relative to higher-earning categories, where utilization rates are relatively similar. You see this growing disparity in biologic use between individuals of different skin colors along that socioeconomic spectrum. The challenge is to understand the factors that contribute to your question. The dilemma is that there are a whole host of factors that contribute. We don’t know which ones are the most significant. Some are particularly intriguing to me.

There was a study looking at biologic use in, I think, patients with rheumatoid arthritis. It showed that African Americans, in general, were more concerned about the risk of medications than White individuals. One reason for the observed disparities or discrepancies between the biologic use may be the perception of the patient. What this essentially requires from us, as clinicians, is cultural humility: to be able to understand what’s really important to the patient, to try to understand what the barriers are to individuals receiving a therapy that may truly be beneficial for them. There may be some reluctance. That’s 1 of the big factors.

The other substantial 1 relates to unmet social needs. In the population in which I work, for commercially insured individuals, traditionally benefit design is equal. This means that employees, whether you’re in a low-wage category or a high wage category, pay the same premium and have the same deductible for benefits. These medications aren’t inexpensive, and most employers—a significant majority—don’t account for affordability concerns. Patients are left with a choice: do they take that medication and potentially incur substantial debt, or do they forgo the medication and use a less effective treatment. [The latter] may result in sustained symptoms and functional impairment that could have been overcome if they had received the biologic medication. As time goes on, as we learn more about these various factors and components—that research is ongoing—we’ll have a much clearer sense of the opportunities to intervene to provide more effective, more equitable care to individuals.

Ryan Haumschild, PharmD, MS, MBA: I can tell you’re so passionate about this topic.

Bruce Sherman, MD, FCCP, FACOEM: Yeah.

Ryan Haumschild, PharmD, MS, MBA: I am as well. It’s an important thing for us to consider for all patients, specifically in psoriasis, because if they’re not receiving the right treatment, that’s such an opportunity. Also, quality-of-life impacts are different based on unique patient types as well.

Transcript edited for clarity.

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