Benjamin Lockshin, MD: Oral Treatment Options for Plaque Psoriasis

Benjamin Lockshin, MD

Credit: DermAssociates

In an interview with HCPLive, Lockshin, director of the Clinical Trails Center at DermAssociates, discusses his research “A Peer Perspective on an Oral Treatment Option for Adults With Moderate-to-Severe Plaque Psoriasis,” presented at the 2023 Fall Clinical Dermatology Conference.¹

What are the most common treatment approaches you typically recommend for patients with moderate to severe plaque psoriasis?

In terms of treating moderate to severe plaque psoriasis, there are several factors to consider. We evaluate the patient's comorbidities, their preferences, the risk-to-benefit ratio, as well as data from previous treatments. We have a range of treatment options, including oral medications and systemic treatments. Newer-generation biologic therapies such as risankizumab, guselkumab, and secukinumab have shown promise. Additionally, there's an oral option, tyrosine kinase 2 (TYK2) inhibitors, which some patients prefer due to their perceived safety and convenience.

How does shared decision-making play a role in selecting treatment options for this patient population?

Shared decision-making is crucial when choosing treatment for patients with plaque psoriasis. Recent studies have shown that involving patients in the decision-making process increases their commitment to the treatment plan and compliance. Educated patients who understand the risks and benefits of various treatments are more likely to adhere to their treatment regimens, leading to better outcomes.

Can you provide insights into the current landscape of oral treatments for plaque psoriasis and the existing gaps or challenges in this field?

The oral treatments for plaque psoriasis have evolved over the years. Traditional options like methotrexate have been largely replaced by newer treatments. Apremilast has been available for about a decade, but its efficacy can be inconsistent, and patients often experience side effects like headache, diarrhea, and nausea. TYK2 inhibitors represent the latest entry into the oral treatment space and have shown a more favorable side-effect profile. Patients can generally expect to feel better with TYK2 inhibitors, and the day-to-day side effects are minimal. However, being a newer medication, there are still some unanswered questions, and we are continually monitoring the side-effect profile.

Are there any recent or emerging developments in oral treatments for plaque psoriasis that you find promising or noteworthy?

There's ongoing research into small molecules that target cytokines previously primarily addressed by biologic agents. These small molecules aim to target interleukin (IL)-23, and some are in phase 1 or phase 2 development. They offer a more targeted approach, similar to biologics, but with the convenience of an oral administration route.

Is there anything else you'd like to convey to our audience or any key takeaways from your presentation that we haven't covered?

Our understanding of psoriasis as a systemic inflammatory condition continues to evolve. Having a broader array of treatment options allows us to choose the most appropriate treatment for individual patients. This not only helps manage their skin symptoms but also addresses the various comorbidities associated with psoriasis, including psoriatic arthritis.

This transcript was edited for clarity.

References

1. ^{Lockshin, B. A Peer Perspective on an Oral Treatment Option for Adults With Moderate-to-Severe Plaque Psoriasis. Presented at: Fall Clinical Dermatology 2023 Conference. Las Vegas, NV. October 19 – 22, 2023.}