Modern Therapeutic Approaches to Psoriasis with Jeffrey Cohen, MD

The 2024 American Academy of Dermatology (AAD) Annual Meeting featured a presentation titled ‘Psoriasis: Modern Therapeutic Approaches,’ with contributions by Jeffrey Cohen, MD, of Yale School of Medicine.

During the AAD presentation, the symposium focused on several different elements of the newest therapeutic approaches to psoriasis, with much of the talk covering injectable biologics. Cohen’s discussed his portion with HCPLive, focusing primarily on comorbidities and selection of biologics.

“During my talk, we walked through a lot of this so that people would feel comfortable using medication safely and so that people would feel like they knew which comorbidities were important to consider when choosing a treatment,” Cohen explained. “Some of the main comorbidities that we discussed were psoriatic arthritis, which is an inflammatory arthritis that goes along with psoriasis, something like 40% of patients with psoriasis go on to develop psoriatic arthritis.”

Cohen noted that psoriatic arthritis patients often require systemic therapy in order to avoid permanent disabling joint damage. He added that it is important to understand which biologics are ideal for patients who have both psoriasis and psoriatic arthritis.

“It turns out actually that tumor necrosis factor alpha inhibitor, TNF-alpha inhibitors, have really strong data for psoriatic arthritis,” he said. “So a lot of rheumatologists, when they're confronting a patient with psoriasis and psoriatic arthritis, do actually like these medications because of the long track record of success that they have. As we in dermatology know, many of our newer medications, many of them approved for psoriatic arthritis as well as psoriasis, do a better job of clearing the skin.”

Cohen explained that some of these treatments, and specifically some of the interleukin (IL)-17 inhibitors, are known to provide relief to patients’ joints. Cohen highlighted that it then becomes a discussion of whether the skin disease or the joint disease is prominent in a patient.

“Fortunately, all medications that are FDA-approved for psoriasis are okay for psoriatic arthritis, and there are none that are really contraindicated,” Cohen said. “Almost all of them are either FDA approved or have really strong clinical trial data for them. And the medication that I'm thinking about is bimekizumab, which was recently approved for psoriasis. The phase 3 clinical trials for psoriatic arthritis were really strong.”

Cohen explained that he anticipates the treatment will eventually have an FDA label for psoriatic arthritis, specifically.

“We also thought a lot about inflammatory bowel disease and we know that inflammatory bowel disease is a comorbidity that can come up in patients with psoriatic disease,” Cohen said. “It turns out that actually many of the medications, including many of the TNF-alpha inhibitors, the IL-12/23 inhibitors ustekinumab, some of our IL-23 inhibitors including risankizumab, are FDA approved for inflammatory bowel disease as well as for psoriatic disease. However, it's important that individuals with inflammatory bowel disease not be treated with IL-17 inhibitors.”

The reason Cohen highlighted for this is that there have been reports of patients being treated with IL-17 inhibitors who had worsening of their known inflammatory bowel disease. Additionally, there were some cases he highlighted of patients developing inflammatory bowel disease while on these treatments.

“And that's an important takeaway, because we do see this quite often,” Cohen said. “It's something that we do need to be careful about. We also talked a bit about moderate to severe heart failure, which is one that requires you to avoid TNF-alpha inhibitors. We talked a little bit about a history of malignancy, which is a tricky one. You want to be careful with TNF-alpha inhibitors there. There's really not a lot of strong data for the other agents. But in a lot of cases, they can be used safely if you work with oncology and the oncologist is on board with this.”

For any additional information, view the full interview segment posted above.

The quotes contained in this discussion were edited for clarity.