Evolution of Plaque Psoriasis Treatment

Alexa Hetzel,MS, PA-C: So, Darren, let’s talk about the implications of the current expansion of therapeutic landscapes and all of the approvals that we have of various biologic therapies for the management of plaque psoriasis. How significant is it that we have such an arsenal of therapies to treat patients, and how has it shifted your practice approach in treating these patients?

Darren West, MPAS, PA-C: Thank you so much for having me on. All of us dinosaurs who have been practicing in dermatology for 20-plus years all know too well, like you've mentioned, that we've had people on so many different products. It ha been frustrating. We started doing cyclosporines, methotrexates, a lot of systemic products, 20-plus years ago, and that was all we had other than Goeckerman therapy. We were used to just giving patients very difficult, very laborious, time-constraining products that just required a lot of work. We would go home at night from work, and oftentimes, we would think about our patients quite a bit. We were worried about them and how our therapy was going to go. Today, with the new landscape of medicines, we've got a lot of these monoclonal antibodies, we've got these new creams, we've got so many options. It is a complete 180 compared to 20-plus years ago.

From my perspective, it’s pretty incredible. I am so excited. We were writing prescriptions for etanercept and some of those other biologics about 20 years ago. That’s about when we first started writing them. We were writing them off label at the time, but we were just excited to have something different, so we were trying as best as we could to get some of these medications to our patients any way possible because we just didn't like writing all those other medications. You know, we would do it, we had no options and our hands were tied. Every patient that came through the door was always asking, “Is there something different? Is there something new? Is there something else I can try?” And we were just waiting and waiting. So, to be honest, the implications are great. We now have so many options, so many different things in our arsenal that we can almost immediately have a patient walk into out office and tell them immediately which type of medication that they would work well on. That’s the coolest part about it, you’ll know, you’re in IL-23, you have a joint involvement, you might be an IL-17, maybe you don’t like shots so we’re going to give you an oral medication. We've got a couple of oral medications now. I mean, this is great, and it’s just exactly what we needed. It helps our life to be easier, and we don’t have to go home at night and worry about what our patients are getting into. So that’s kind of nice, and we’re happy for that. I’m happy for that.

Alexa Hetzel,MS, PA-C: Peace of mind all the way around.

Darren West, MPAS, PA-C: Absolutely.

Alexa Hetzel,MS, PA-C: I love it.

Douglas DiRuggiero, DMSc, PA-C: From 2013 to 2020, we had a new biologic that was launched. It was 7 years in a row that we have 1 per year, and really, in 2017, we had 2. So, it is incredible to think about. We've got 11 biologics now, Darren, as you said, and we have a 12th that may be approved soon, and then the orals that have come out also. So I’m with you there, in terms of seeing how things have changed. It’s very dynamic and ever-shifting, starting to settle now, but now the orals are bringing a new face to it; very exciting.

Transcript edited for clarity