Should biologics be used for milder cases of psoriasis?


The remarkable effectiveness of biological products for moderate to severe psoriasis has led some to wonder whether organic products should be used in milder cases.

The topic was addressed in a debate at the American Academy of Dermatology Virtual Meeting Experience (AAD VMX) 2021.

Taking the opposite side, Kenneth Gordon, A doctor of medicine, professor and chair of dermatology at the Medical College of Wisconsin, Milwaukee, argued that, with the high cost of biological products, the availability of many alternatives and other issues, “we should just say no … There is no good reason why we need to expand the use of biological products in patients with limited diseases. “

Dr. Kenneth Gordon

For the professional part, Richard Langley, MD, a professor of dermatology at Dalhousie University in Halifax, Nova Scotia, Canada, advocated a nuanced approach. He noted that patients with smaller disease spots can be as unfortunate as patients who reach more severe traditional benchmarks, such as high body surface involvement, especially if these small areas are in sensitive places such as the scalp, hands, or genitals.

The decision to use a biological product should depend on the impact on patients and their quality of life, not on “some artificial and limiting definition” of severity, Langley said.

Gordon disagreed, noting that current use criteria include objective measures, as well as diseases in sensitive areas and the failure of alternative treatments.

Rather, he was concerned with “broadening the definition of who is eligible beyond these criteria … to pursue to the last piece of” disease. “I don’t think we have” a good reason for that approach, he said.

Cost is the most important issue, Gordon said.

With more organic products underway and prices continuing to rise, “there will be a big challenge for our payers that we use these expensive drugs for years to come.” “It’s important that we use them intelligently to make sure we can use them for people with serious illnesses” who really need them. If we “start using biologics for all of our psoriasis patients,” it will be a “cost disaster,” Gordon said.

In addition, clichés and phototherapy at home it can be effective as long as patients adhere to it, as well as alternative systemic agents, such as methotrexate i apremilast.

Often with organic products, “the issue is primarily comfort” rather than a fundamental issue with alternatives, and despite the good safety record in trials, “chasing the last bit” of psoriasis with a biological product “doesn’t it is necessarily “risk – free for the patient,” Gordon said.

Still, there may be a “fairly significant disconnect” between how patients perceive their psoriasis and “what doctors are thinking and prescribing” for it based on objective measures, Langley noted. Sometimes patients who present with a limited illness but who present with significant distress do not even receive treatment or are only given another cream to add to their collection of products that have not worked.

One problem with traditional severity classifications is that they do not usually take into account patients ’subjective experience, he added. There has also been a lack of standardization to the point that dermatologists, researchers, and contributors can sometimes disagree about the severity of a particular patient.

There is a move toward better incorporation of the patient experience into severity considerations, but at least for now, a designation of mild psoriasis may underestimate the actual severity of the disease, Langley said.

Drs Gordon and Langley reported that they received fees and / or research support from many pharmaceutical companies, including AbbVie, Pfizer and Lilly.

Experience of virtual meetings of the American Academy of Dermatology (AAD VMX) 2021.

M. Alexander Otto is an assistant physician with a master’s degree in medical sciences and a Newhouse degree in journalism from Syracuse University. He is an award-winning medical journalist who worked for McClatchy and Bloomberg before joining Medscape and also a fellow at the MIT Knight Science Journalism. Email: [email protected]

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