Unmet Needs in Plaque Psoriasis Treatment

Alexa Hetzel, MS, PA-C: Jayme, given the recent approvals for the management of plaque psoriasis, what unmet needs still remain in both research and clinical treatment of these patients?

Jayme M. Heim, MSN, FNP-BC: There’s always going to be a number of medications we have; however, not all medications work for each person we treat. We’ve learned this from previous experience. Sometimes even from class to class, with certain IL-17s, a patient may do very well on it and then they don’t do as well. We may use another IL-17 and they do extremely well again, or we’ll go ahead and use an IL-23 or an TNF [tumor necrosis factor] inhibitor. We really don’t know. There’s a lot of research being done to try to genotype patients with plaque psoriasis to identify whether they respond to a certain group of medications more so than other groups of medications. I can tell you, being a provider for almost 2 decades, that treating patients with psoriasis is very humbling, because just when you think you have it figured out, something else happens.

The 1 thing we know is that there’s additional research that is ongoing. Do we need additional medications within the psoriasis space? Yes, we do. We just need to identify more. We have certain conditions, like palmoplantar pustular psoriasis, and we really don’t have a good medication for that. We do have medications coming out, whether they’re biologic therapies, and there are different small molecules that are coming out. There’s always room for everybody at the table when it comes to treating patients with psoriasis.

There is a true unmet need in regards to oral therapies for pediatric populations. For the pediatric population, we do have injectable therapy or methotrexate therapy, but we also have all the problems that come along with treating with methotrexate therapies—the frequent blood draws, the monitoring, and everything else—not to mention the fact that, with girls of childbearing age, it’s contraindicated. So, it’s really nice to know there are small molecules that are being tested to treat patients aged 12 to 18, and that’s really important.

Scalp psoriasis is another area that is very difficult to treat….We’ve tried a lot of biologic therapies. We also have a lot of studies that have been done with the current biologic therapies that we have looking at scalp psoriasis. There are also small molecules being used to treat scalp psoriasis. One of those that are in the development right now is deucravacitinib, which we talked about earlier. It’ll be really interesting as time goes on as other molecules are developed within this space to help patients with psoriasis.

Transcript edited for clarity