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- Presentation
Real World Therapy Selection in Psoriasis
Description
The discussion centers on the complexities of selecting therapies for psoriasis in a real-world clinical setting, emphasizing that treatment choices involve multiple factors such as efficacy, safety, cost, and patient preferences. Since 2004, the introduction of targeted therapies has significantly improved outcomes, particularly regarding effectiveness and safety. Key head-to-head trials, like Spirit and Ixora R, have provided insights into the superiority of certain biologics like ixekizumab over adalimumab for joint and skin efficacy, and highlighted the fast-acting nature of agents like bimikizumab versus secukinumab. The speaker stresses the necessity of considering treatment speed, efficacy across different manifestations (scalp, palms, and soles), and patient-specific factors, including how they may respond differently in real-world scenarios compared to clinical trials. A notable point is that while biologics generally outperform oral medications in effectiveness, some patients still prefer oral treatments for convenience. The role of shared decision-making in therapy selection is emphasized, encouraging healthcare providers to engage with patients about their preferences and experiences. Overall, the presentation advocates for the use of interleukin 23 inhibitors and bimikizumab as first-line treatments due to their strong efficacy and favorable safety profiles, urging practitioners to take an individualized approach when determining the best therapeutic strategy.
View moreConclusions
- The introduction of targeted therapies has significantly improved the efficacy and safety of psoriasis treatments since 2004.
- Efficacy in both skin and joint conditions should be considered when selecting therapies for patients with psoriasis.
- Ixekizumab (IXI) demonstrates superior skin clearance and joint protection over adalimumab (ADA) in patients with both skin and joint disease.
- The speed of achieving efficacy is a crucial factor in therapy selection, with IXI showing faster results compared to guselkumab.
- Bimekizumab (BIM) provides faster and greater responses than secukinumab (SEC) and is associated with a higher rate of complete skin clearance.
- Patients with specific conditions such as scalp psoriasis benefit greatly from treatments with IL-17 inhibitors.
- The choice of systemic therapies should incorporate patient preferences, cost considerations, and individual comorbidities.
- For patients with low body surface area but high-impact psoriasis manifestations, targeted therapies like Jack inhibitors may be more effective.
- Rising evidence supports the use of biologics such as risankizumab (RZB) over apremilast, demonstrating better efficacy in clearing psoriasis.
- Long-term therapy considerations emphasize the importance of drug survival rates, with IL-23 and BIM showing better longevity in treatment compared to other options.
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