Many Medications: Understanding the Biologic Management of Psoriasis

He went on to explain that the NPF recommends a treat-to-target approach in the management of patients with skin psoriasis, with the preferred target response being <1% BSA at three months and during the maintenance phase thereafter. An acceptable response is defined as <3% BSA or >75% BSA improvement with treatment.

Concluding Thoughts

To conclude his talk, Dr. Fernandez indicated two main questions still loom large in the field of psoriasis research:

1. Does biologic therapy decrease the incidence of major adverse cardiovascular events (MACE)?
2. Can biologic therapy prevent the future onset of psoriatic arthritis?

Both questions remain under active investigation, and for the latter question, a paper from Singla et al. provided interesting insights. The authors of this article found that in a large cohort study of patients with psoriasis, treatment with IL-12/23 inhibitors or IL-23 inhibitors was associated with a reduced risk of progression to inflammatory arthritis, compared with TNF-α inhibitors. This finding, if borne out by prospective observational cohorts and pooled analyses of previous randomized trials, may indicate the mechanism of action of treatment matters in potentially altering the future risk of psoriatic arthritis.⁶

Although this presentation did not delve deeply into the treatment of psoriatic arthritis, it was helpful to hear discussion of a dermatologist’s approach to the treatment of skin psoriasis.

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Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

References

1. Damiani G, Bragazzi NL, Karimkhani Aksut C, et al. The global, regional, and national burden of psoriasis: Results and insights from the Global Burden of Disease 2019 Study. Front Med (Lausanne). 2021 Dec 16;8:743180. eCollection 2021.
2. Mehta NN, Azfar RS, Shin DB, et al. Patients with severe psoriasis are at increased risk of cardiovascular mortality: Cohort study using the General Practice Research Database. Eur Heart J. 2010 Apr;31(8):1000–1006.
3. Abuabara K, Azfar RS, Shin DB, et al. Cause-specific mortality in patients with severe psoriasis: A population-based cohort study in the UK. Br J Dermatol. 2010 Sep;163(3):586–592.
4. Reich K, Gordon KB, Strober BE, et al. Five-year maintenance of clinical response and health-related quality of life improvements in patients with moderate-to-severe psoriasis treated with guselkumab: Results from VOYAGE 1 and VOYAGE 2. Br J Dermatol. 2021 Dec;185(6):1146–1159.
5. Sbidian E, Chaimani A, Garcia-Doval I, et al. Systemic pharmacological treatments for chronic plaque psoriasis: A network meta-analysis. Cochrane Database Syst Rev. 2022 May 23;5(5):CD011535.
6. Schultheiss JPD, Brand EC, Lamers E, et al. Earlier discontinuation of TNF-α inhibitor therapy in female patients with inflammatory bowel disease is related to a greater risk of side effects. Aliment Pharmacol Ther. 2019 Aug;50(4):386–396.