In this video, George Han, MD, PhD, discusses the need to better understand how antibodies affect our patients with psoriasis.
Dr Han is the assistant medical director for dermatology at Mount Sinai Health System, assistant professor and chief of teledermatology for the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, NY.
Dr Han: One of the challenges when we're thinking about the idea of neutralizing antibodies and drug antibodies is that we're dealing with, for most of the medications, low numbers of patients. It's hard to draw big conclusions from those when we're talking about just a cohort of 10 patients in some cases, for example.
Some further research into the role of these antibodies especially center around that idea of that secondary loss of efficacy, because in my mind, that's a big concern. When we're talking about looking at different options, we think about number one, when we have to switch a patient from one biologic to another, that's a very expensive prospect.
It's been shown again and again that those first‑year costs tend to be much higher than the maintenance costs. Whenever we switch somebody, there's absolutely a cost to society, a cost to health care for that. If we can identify the patient, either maybe through some genetic testing, or something where we can identify the patient as an ideal candidate for this medication. Or, we have some better way of understanding mechanisms of secondary loss of efficacy. In some cases, for example, when we think of neutralizing antibodies, we might combine treatment with methotrexate with the biologic to prevent those antibodies from forming. If we have strategies to combat it, it helps too.
We shouldn't understate the psychologic impact of getting somebody clear on a biologic or close to it, and then having their psoriasis come back. That carries a heavy burden with it as well, and we ought to try to minimize the occurrence of that as much as we can.
In summary, a lot of great choices for psoriasis treatment now. We're lucky to have a wide array of different medicines that have a long track record, for the most part, of treatment efficacy, safety, and durability. I'm looking forward also to getting some more information and studying this idea of subtleties and differences in the patient presentation that can help guide our treatment.
Not just the idea of necessarily performing tests, but also examining, is this a patient where the scalp psoriasis is predominant, palmoplantar? What are the relative contributions of the psoriatic arthritis and the other portions to their other impacts on quality of life?
Getting more head‑to‑head trials of these special sites, head‑to‑head trials of patients with psoriasis, palmoplantar disease, psoriasis with scalp disease, will help us understand which patient fits which medication better. That idea of personalized medicine between our testing and our ability to stratify patients based on the initial presentation.
We'll be in a better place, we'll be able to get the right treatment into the hands of our patients earlier on.