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LIVE BLOG: Evaluating Psoriasis Severity [Product Theater: Amgen / Enbrel]

Rob Casquejo is a Derm PA with his own practice in Scottsdale, Arizona, presenting on behalf of Amgen.  In this product theater he highlights the efficacy of Enbrel.

 

Treatment Considerations:

As Derm PAs, how can we evaluate psoriasis severity?  Use the AAD guidelines of care for the management of psoriasis and psoriatic arthritis, which encourages the following:

“Actively seek signs and symptoms of Psoriatic Arthritis at every visit, including in patients with limited disease.” 

Look for: 

1. BSA involvement

2. Symptoms

3. Location of Ps

4. Thickness of plaques

5. Presence or absence of PsA

6. Subjective assessment of impact on patient’s life

 

 

Psoriatic Arthritis is a debilitating disease.  It is as debiitatingl as rheumatoid arthritis.  We cannot ignore the potential symptoms of PsA when we find plaque psoriasis.  

 

Specifically, Signs & Symptoms of Psoriatic Arthritis Include:

+ Red & inflamed skin of psoriasis.

+ Pain and swelling in the joints.  It may be worse in the morning or after rest. Activity often helps lessen stiffness.

+ A Sausage-like appearance in the affected fingers and toes (in severe cases.)

+ Small indentations on the nail, or the nails may pull away from the nail beds.  Look for ridges or a yellowish-orange discoloration on nails.

 

The lecturer suggests getting Rheumatologists involved.

Plaque psoriasis, even one single patch on the hands can be destructive psycho-socially.

 

ENBREL.

1. Is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

2. Is technically an immunosuppressent medication, which can lead to other adverse events. 

3. Results from Clinical Trials shows a consistent PASI 75 improvement from baseline: demonstrating predictive efficacy for Enbrel.

Enbrel demonstrates a good patient experience over a long-history: There’s no other patient data collection for a biologicl for psoriasis.  Data goes back to 1993 for safety data and efficacy.  This medicine has been used for 20 years, without a lot of problems.

 

CHALLENGING CASE STUDY (hypothetical)

 

Diagnosis: 35 year old woman with 10 year history with moderate to severe plaque psoriasis.

Status: Chief complaints are itching, burning, pain.  She is embarrassed due to plaque being on hands and legs.  

Treatment Considerations: She travels tons for work, has to get a flu vaccine for work.  

Discussions:

1. What would be your treatment goals?

2. What factors do you consider when deciding on treatment?

3. How does the ability to recapture response affect your decision?

4. Do you have patients who have had to discontinue therapy due to circumstances such as surgery or change of job/insurance?

 

Questions About Discontinuing Treatment?

*Can you re-capture the efficacy if you stop Enbrel?  Yes.  Studies show you could stop for 3 months, and it takes about 16 weeks to get back to same efficacy.

 

Some Safety Info to Remember:

Prior to prescribing, it is recommended that you test for Hep-B, Hep-C, and HIV.

 

[image by candidaperforma]