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Treatment Landscape and Final Thoughts


The KOLs discuss the evolving treatment landscape and share their final thoughts.


Peter L. Salgo, MD: I heard Peter Dehnel say that we’re going along with standard therapy, and along came this drug—a game changer. And then it couldn’t possibly get better, but it did. And then we thought it couldn’t possibly change for the better, but it did. What is your view on the way the landscape of treating this disease is going? Where are we going to be in 10 years?

Steven Feldman, MD, PhD: I think we’ll have biosimilars for the things we have now. And patients like pills, they don’t like shots. So maybe we’ll get to the point, somebody will develop a ROR [retinoic acid-related orphan receptor] gamma-T inhibitor that inhibits the IL-23 [interleukin-23], IL-17 pathway with an oral, small molecule that doesn’t have a lot of adverse effects. If you can come up with that, that would be a game changer.

Joel Gelfand, MD, MSCE, FAAD: Yes, I think that there’s certainly a lot of unmet medical need for all medications that are highly effective but as well tolerated and safe as some of the injectable medications are—that’s certainly a place we’ll go. I think as the research unfolds, we’ll try to better understand the treating of the disease a little bit earlier, we’d like to know if it will bend their comorbidity curve and lower their rate of progressing to more severe disease over time. That’s also a place where I hope we’ll have more information.

Peter L. Salgo, MD: And is step therapy going to go away? Will they go right to these biologics?

Peter Dehnel, MD: That’s unlikely. I think what we do need from some sort of a payer-provider partnership is compliance adherence. Because if these medications are that good and they are that effective, which certainly sounds like they are, if they’re not taking their medication, they’re not going to get the benefit.

Peter L. Salgo, MD: Gotcha. You know, in the time we have left why don’t I give each of you just a moment to say something pithy, something you’d like our audience to take away from this discussion. Why don’t we start right here?

Steven Feldman, MD, PhD: I don’t want to ruin what Joel might have to say.

Peter L. Salgo, MD: It’s always hard being on this side.

Steven Feldman, MD, PhD: I would say for the patient who has moderate to severe psoriasis, you cannot have a monobiologic at all, if you can get them under control with light therapy. And so unfortunately coming to our office is very inconvenient, costly to patients, and stuff. Just get them a home light unit. Say if you got a prescription for a biologic and you say, “Here’s a home light unit, use this for 3 months.” If it didn’t work for anybody, you still saved money because you kept the patient off biologics for 3 months.

Peter L. Salgo, MD: Go ahead, you’re up.

Peter Dehnel, MD: I think there are obviously a lot of new opportunities in this space to really improve patient outcomes and patient care. I think insurers are, believe it or not, interested in helping people get to a higher level of health, a higher level of care, but we need strong society guidelines, and we also need the help of the provider community to really ensure people are getting the care that they need.

Peter L. Salgo, MD: You’ve got the last word.

Joel Gelfand, MD, MSCE, FAAD: I think we have to think more holistically about patients with psoriasis. Try and improve outcomes, not just in their skin but beyond the skin: their joints, their cardiometabolic diseases, their mental health, well-being. That often takes a team approach, organizational approach, working with their payers as well.

Steven Feldman, MD, PhD: The National Psoriasis Foundation is another good resource that payers, patients, doctors can make use of.

Peter L. Salgo, MD: I want to thank all of you for being here. What a great discussion. And on behalf of our panel, I want to thank all of you out there for joining us. I hope you found this Peer Exchange discussion to be useful and informative. I’m Dr Peter Salgo and I’ll see you next time.

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