Brad Glick, DO, MPH: Long Term Results for Adults with Plaque Psoriasis, Psoriatic Arthritis

During this HCPLive interview, Brad Glick, DO, MPH, spoke about the major points covered in his presentation given at the Fall Clinical Dermatology 2023 Conference for PAs & NPs.

Glick is known for his work as a dermatologist with Glick Skin Institute and as assistant clinical professor of dermatology at the Herbert Wertheim College of Medicine at Florida International University.

HCPLive: Your conference talk is entitled “Results in Skin for Adults with Moderate to Severe Plaque Psoriasis and in Joints for Patients with PsA.” What led you to present on this topic?

Glick: Well, this is a talk that is primarily focused on psoriatic disease, and I say disease because we're not just focusing on psoriatic skin disease. We're really looking at the whole patient. About 30% of patients with psoriasis, we'll move on to develop psoriatic arthritis. And really, the content of this talk focuses not only on the skin manifestations, and also results from some clinical trial data from an interleukin-23 inhibitor.

But it also focuses on the benefits that our patients can obtain from being on such a therapy and interleukin 23 blocker. In terms of potential development of psoriatic arthritis recently, there actually is some literature, a report from the British Journal of Rheumatology, that actually focuses on the benefits of interleukin-23 and potentially preventing the delay, if you will, of the development of psoriatic arthritis. And so it's a very interesting time.

HCPLive: What were some of the major takeaways from your presentation that you believe could be important to highlight for our clinician audience?

Glick: From the standpoint of the use of interleukin-23 blockers in managing psoriatic disease, we've reached an amazing time if I think back to my now 28 years of dermatology practice, when biologics first came to market. Now, think of the early TNF-inhibitors or tumor necrosis factor inhibitors.

We could say to our patients, even retrospectively, as we know it now, they had about a 10 to 15% chance of getting 100% clear with interleukin-23 blockers, we can now see not only from the clinical trial data. But in the trenches where we all work, we see at least 50% of the patients getting 100% clear at the end of the year.

So this is a remarkable advance in our ability to treat these patients with psoriatic disease. Similarly, I also will talk about psoriatic arthritis and of course, the potential effects that interleukin-23 blockers can have on individuals who develop psoriatic arthritis.

Some of the points that I brought out in the clinical trial for psoriatic arthritis were the really profound responses that the patients get not only with the ACR20. Those are the benchmarks that we have in clinical trials for psoriatic arthritis. But some of the higher level responses we can see, like 50% improvement in the American College of Rheumatology scoring system, if you will, to measure the response in the joints for clinical trials for psoriatic arthritis. So those are some of the highlights of my talk.

HCPLive: Was there any clinical trial data you highlighted in your presentation?

Glick: Some of what we talked about in terms of real world data, in terms of psoriatic arthritis is 1 example…I referenced in this particular talk that I do something called minimal disease activity, which is a way of measuring not only the clinical response in the joints, but it addresses how the actual patients feel, how it impacts their quality of life. It's 1 of the ways that is a little bit different than when we look at the inhibition of progression of disease, often we do that radiographically.

But this is another way of looking at how we can improve an individual's joints overall, and also their quality of life overall. And in my opinion, and I think in the opinion of some of my rheumatology partners, this is just another way that we can measure the blockade to the progression of disease. Because once someone develops psoriatic arthritis, the potential for the progression and the disability that it can impart is substantial.

So those are really some of the other highlights and in terms of the clinical trial data that I presented as well. And I would say that I referenced, you know, overall, in terms of overall skin responses going back to the skin, that we have therapies, now we're getting pretty close to about 70% of our patients achieving 100% clearance.

So with that, combined with our ability to substantially improve their joints, whether it is with interleukin 17 blockers, as in my talk with interleukin 23 blockers, we have an incredibly successful toolbox for managing our patients with psoriatic disease.

HCPLive: What are some of the larger implications for some of the data that you presented here?

Glick: I think that we don't get 100% of our patients clear where skin disease is concerned 100% of the time. So clearly, we will want to subscribe to the idea of getting patients clear all the time. And as we would like to say, potentially finding a cure. But right now, the advances that we made have really been remarkable, I think clinical trial research and psoriasis is still trying to find that magical bullet that will get higher levels of response. And moreover, looking for remit of effects.

And for instance, there are some studies that are being done right now that are actually looking at giving patients a singular injection and specifically, as I referenced in my talk which is about interleukin-23 blockers, a singular injection of interleukin-23 blockers. And looking at that time frame for which they start to develop a return of disease once they've gotten 100% clear.

And in my experience, we do have some patients who have a pretty substantial amount of body surface area of involvement in the trenches where I am practicing in clinic, whether it's with residents, or in the private clinic, and we will see some patients back after just 1 month following their initial injection of an interleukin-23 blocker and their skin is completely clear.

So I think what the future is going to look at is how long can that be sustained? Are there different dosing regimens? Should we use higher doses that are front loaded to get a more sustained response for a longer period of time? I think now that we've been able to reach these high level responses, can we really hold them for much longer periods of time, until such time that maybe matters such as gene therapy will enable us to impart a cure for these patients with psoriatic disease?

To learn more about conference coverage, view the conference page here.

The quotes contained in this article were edited for clarity.