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Live Blog: Practical Issues Using Biologics for Psoriasis. Faculty: Steven R. Feldman, MD, PhD


In this live blog from the Annual Fall SDPA Conference in Orlando, Steven R. Feldman, MD, presented a lecture on the practical uses for biologics to treat psoriasis. Here are some of the highlights.

Dr. Steven R. Feldman opened his lecture by arguing for the safety and efficacy of biologic approaches to treating psoriasis. Feldman focused on the success of a biologic treatment approach but he also acknowledged that biologics could present many challenging variables for the healthcare provider, patient, and insurers.

What are the approach options to treating psoriasis? Here are the AAD guidelines: If a patient’s psoriasis is localized, topicals are a reasonable treatment. UVB is safe, effective and cost effective (PUVA therapy is very effective, but has greater risks). Methotrexate is effective, but has many risks. Cyclosporine is best used only intermittently. Acitretin is not immunosuppressive, but is teratogenic.

Well, then when are biologics the advisable approach? If a patient has spots of psoriasis on 6% or more on their body, Feldman recommended a biologic treatment approach. There are challenges, however, getting a patient on board with a biologic approach. As a patient considers a treatments efficacy, they are also considering the cost, the potential side effects, and the recovery experience.

Biologic treatment is a costly approach. Often the healthcare provider will be at the mercy of the insurance company and/or the patients’ prerogative to pay less. Methotrexate, for example, is a non-biologic drug that is riskier than a biologic (Feldman argued that Methotrexate treatments result in patient fatalities every year), however it is a cheaper treatment.

Feldman touched on the efficacy of patient self-administered drugs and the potential challenges in patients regularly and consistently taking the drug. Here are some tactics Feldman advises:

– Follow up with the patient, asking them about their concrete routine for taking the biologic: “Are you keeping the extra syringes you’ve accumulated refrigerated like you’re supposed to?”
– Put the patient’s mind at ease by explaining that a biologic treatment is an all-natural anti-inflammatory made in living cells that complement your body’s natural healing mechanisms. It is a holistic approach to skin disease.
– Keep your patient educated. The National Psoriasis Foundation has terrific and helpful resources (such as brochures) to inform the patient on their condition and treatment options.

And a helpful note for pregnant patients with psoriasis:

Biologics are category B drugs and Feldman will prescribe biologics to pregnant patients. However Feldman cautioned that 10% pregnancies have bad outcomes and biologics may be blamed. Feldman strongly advised providers check with the obstetrician before prescribing.

Image: Victor Camilo

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