EXPERT ANALYSIS FROM SDEF LAS VEGAS DERMATOLOGY SEMINAR
While anti–tumor necrosis factor (TNF)-alpha medications have shown effectiveness for psoriasis, ongoing issues include optimizing therapy, managing treatment in special populations, and comparing the drugs with newer therapies, according to Dr. Francisco A. Kerdel.
Among the concerns regarding optimizing anti–TNF-alpha therapy are loss of response, continuous versus intermittent dosing, combination therapy, and long-term safety and efficacy, Dr. Kerdel, professor and vice-chair of the department of dermatology, Florida International University, Miami, said in a presentation at the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.
In a PSOLAR (Psoriasis Longitudinal Assessment and Registry) study of approximately 2,000 patients treated with the TNF-alpha blockers – adalimumab, etanercept, or infliximab – or with the interleukin-12 and -23 antagonist ustekinumab, patients in each treatment group showed significant improvements from baseline at 6 months and 12 months on both Physician Global Assessment scores and scores on the Dermatology Quality of Life Index ( J Am Acad Dermatol. 2016 May;74:851-61.e4 ).
However, “no evidence-based guidelines are available for screening and monitoring patients receiving biologic therapy for psoriasis,” Dr. Kerdel noted.
Patient factors that impact the choice and potential response of anti–TNF-alpha therapy include not only physical issues such as weight, disease activity, and comorbidities, but also patient preferences for simpler dosing regimens or a desire to avoid injections, he said.
Despite these issues, there is currently no consensus on and no guidelines for switching treatments after failure with an anti–TNF-alpha agent, he noted.
Other questions associated with anti–TNF-alpha agents in psoriasis include whether the loading dose recommended by most drug labels is necessary, according to Dr. Kerdel. “In practice, many clinicians omit the loading dosage and initiate therapy with maintenance doses,” he said. In addition, “physicians should use clinical judgment when screening and monitoring patients taking biologic agents.”
From a dermatologist perspective, the top unmet therapeutic needs in the treatment of psoriasis were improved efficacy, improved tolerability, improved long-term safety, another oral treatment option, and a new mechanism of action, based on a survey that included 391 dermatologists ( J Eur Acad Dermatol Venereol. 2015 Oct;29:2002-10 ).
As psoriasis treatments evolve, other issues include compiling real-world, postmarketing data on biosimilars; monitoring patients for the emergence of significant adverse events; and searching for biomarkers to help target biologics to specific patients and psoriasis subtypes, Dr. Kerdel added.
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Dr. Kerdel disclosed being a speaker for AbbVie, Amgen, Celgene, Galderma, and Janssen; conducting research for those 5 companies and for Novartis, Pfizer, and Valeant; he is also on the board of Celgene.