Dermatology

Plaque Psoriasis @ SDPA 2024

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Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference Roundup

conference reporter by Douglas DiRuggiero, DMSc, MHS, PA-C
Overview

Advances in the treatment of plaque psoriasis have been extensive over the past several years. Some of the latest scientific and clinical advances related to the treatment of plaque psoriasis were discussed at the recent Society of Dermatology Physician Associates (SDPA) 22nd Annual Fall Dermatology Conference.

 

 

 

Following these presentations, featured expert Douglas DiRuggiero, DMSc, MHS, PA-C, was interviewed by Conference Reporter Associate Editor-in-Chief Christopher Ontiveros, PhD. Mr DiRuggiero’s clinical perspectives and consolidation of these highlights are presented here.

“. . . we have seen this therapeutic renaissance in psoriatic diseases over the past 20 years, moving away from traditional therapies that include methotrexate, cyclosporine, phototherapy, and all the topicals and on to these new systemic therapies that have become very targeted, and this targeting is leading to high efficacy and safety.”
— Douglas DiRuggiero, DMSc, MHS, PA-C

The annual SDPA Fall Dermatology Conference is considered one of the premier dermatology meetings in the country for physician assistants and nurse practitioners. The conference is over 20 years old, drawing top experts each year. It incorporates cutting-edge information, so I think that it is very up-to-date and practical.

 

The topic of plaque psoriasis will always have a prominent position at any dermatology conference because there have been so many therapeutic developments and advances in treating this condition. Since we now have 12 biologics, 2 oral small-molecule medications (a TYK2 inhibitor and a PDE4 inhibitor), and multiple new novel topicals that have entered the psoriasis arena and have been US Food and Drug Administration (FDA) approved in recent years, updates on treatments obviously need to be provided. In short, we have seen this therapeutic renaissance in psoriatic diseases over the past 20 years, moving away from traditional therapies that include methotrexate, cyclosporine, phototherapy, and all the topicals and on to these new systemic therapies that have become very targeted, and this targeting is leading to high efficacy and safety. It has really expanded and guided the way we practice dermatology and care for patients with this inflammatory immune-driven disease that has a multitude of disease comorbidities and co-manifestations.

 

Several significant abstracts were presented at this year’s SDPA conference. One was by Zoe Draelos, MD, and colleagues on the new fixed-combination topical halobetasol propionate and tazarotene. This study did something that was unique in that researchers focused on cytokine signature patterns in actual psoriatic plaques, and they saw a reduction in TNF-α levels inside the psoriatic lesions. So, the topical not only reduces erythema, scales, and induration, but, in this study, it was also associated with a localized reduction of TNF-α levels that were maintained even after treatment cessation. It is having a systemic-like impact on the surface, and that is a unique clinical point to make.

 

At the SDPA 22nd Annual Fall Dermatology Conference, there were also abstracts by April W. Armstrong, MD, MPH, et al and Neil J. Korman, MD, PhD, et al on the oral TYK2 inhibitor deucravacitinib looking at 4-year safety data. TYK2 is a member of the JAK family, and, because of this association, there is still a shadow of doubt among prescribers about whether the safety of deucravacitinib is really different from or similar to that of other JAK inhibitors. These long-term safety data are important because they confirm why this medication does not carry the boxed warnings of the other oral JAK inhibitors. Overall, these studies found that, from baseline, there were no significant observed changes in lipid levels, chemistry panels, hematological parameters, cardiac events, or cancers. It is important to tell those patients who are hesitant to use deucravacitinib about these 4-year safety data and that this agent can be the right treatment for the right patient.

 

The injectable anti–IL-17A/IL-17F monoclonal antibody bimekizumab received FDA approval for plaque psoriasis in the fall of 2023. It was approved a few years prior in Europe and therefore came to the United States with long-term data associated with its use. An abstract by Kenneth B. Gordon, MD, and colleagues about bimekizumab safety and tolerability up to 4 years was presented at the SDPA conference. The study looked at cumulative exposure over time (>4 years), and it showed good tolerability and safety findings that were consistent with findings from previous years.

 

Finally, an abstract by Kim A. Papp, MD, PhD, et al focused on an investigational oral IL-23 blocker that is not a monoclonal antibody, and this is exciting. The problem with monoclonal antibodies is that they are massive proteins that cannot make it through the gastrointestinal tract without being degraded and destroyed. This is why we do not have an oral monoclonal antibody. This novel oral IL-23 blocker is an oral peptide that inhibits IL-23 signaling by binding to the IL-23 receptor. The phase 2 study by Dr Papp and colleagues showed that 76.2% of patients achieved a Psoriasis Area and Severity Index (PASI) of less than or equal to 5, and 71.4% got down to a body surface area of less than or equal to 3% at week 16, which was maintained through week 52. These are similar numbers to those reported for several biologics. We are hoping that, as this oral IL-23 blocker moves forward with clinical trials, there will not be any safety signals or arduous laboratory monitoring requirements that pop up.

References

Armstrong AW, Lebwohl M, Warren RB, et al. Deucravacitinib in plaque psoriasis: 4-year safety and efficacy results from the phase 3 POETYK PSO-1, PSO-2, and LTE trials. Abstract presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

Bissonnette R, Pinter A, Ferris LK, et al. An oral interleukin-23-receptor antagonist peptide for plaque psoriasis. N Engl J Med. 2024;390(6):510-521. doi:10.1056/NEJMoa2308713

 

Draelos Z, Draelos M, Jacobson A. Changes in TNF-α levels in psoriatic plaques after treatment with fixed-combination halobetasol propionate and tazarotene lotion versus clobetasol propionate 0.05% cream. Abstract presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

Gordon KB, Thaçi D, Gooderham M, et al. Bimekizumab safety and tolerability in moderate to severe plaque psoriasis: pooled analysis from up to 4 years of treatment in 5 phase 3/3b clinical trials. Abstract presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol. 2020;182(4):840-848. doi:10.1111/bjd.18245

 

Korman NJ, Passeron T, Okubo Y, et al. Deucravacitinib in plaque psoriasis: laboratory parameters through 4 years of treatment in the phase 3 POETYK PSO-1, PSO-2, and LTE trials. Abstract presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

Papp KA, Ferris LK, Pinter A, et al. Sustained improvements in Psoriasis Area and Severity Index (PASI) and body surface area (BSA) with JNJ-77242113 in patients with moderate-to-severe plaque psoriasis: treat-to-target analyses in FRONTIER 1&2. Abstract presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

 

 

This information is brought to you by Engage Health Media and is not sponsored, endorsed, or accredited by the Society of Dermatology Physician Associates.

Douglas DiRuggiero, DMSc, MHS, PA-C

Certified Physician Assistant
Skin Cancer & Cosmetic Dermatology Center
Rome, GA

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