Dermatology

Plaque Psoriasis @ SDPA 2024

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Special Patient Populations With Psoriasis

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

While the treatment approach for patients with psoriasis can be influenced by a standard patient type included in clinical trials, not all patients fit that demographic. Special patient populations may require different treatment considerations. These topics were discussed at the Society of Dermatology Physician Associates (SDPA) 22nd Annual Fall Dermatology Conference in Las Vegas, NV.

 

 

 

Following this session, 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.

“. . . ongoing and recent data reveal that biologic therapies—not just TNF inhibitors but also anti–IL-17 and anti–IL-12/23 treatments—can potentially decrease the risk of cardiovascular disease in patients with psoriasis.”
— Douglas DiRuggiero, DMSc, MHS, PA-C

At the SDPA 22nd Annual Fall Dermatology Conference, a session by Ken Gordon, MD, and Richard Langley, MD, highlighted the nuances of treating challenging cases of systemic psoriasis. Both speakers presented different challenging patient scenarios and bantered throughout the presentation, so the audience could enjoy the vast combined experience of these highly respected psoriasis experts.

 

Dr Langley spoke first, discussing psoriasis-associated cancer risk. He cited a study in JAMA Dermatology that examined cancer prevalence, incidence, and risk in patients with psoriasis and psoriatic arthritis. The study showed that there was an increased risk of several types of cancer (ie, keratinocyte cancer, lymphoma, lung cancer, and bladder cancer) in patients with psoriasis and that, overall, there was no appreciable increased risk of cancer with biologic use compared with nonbiologic, age-matched psoriatic cohorts. We hope that, with time, we will see an overall decreased risk of cancer in patients with psoriasis who are treated with biologics, but we cannot make those conclusions at this time.

 

Dr Gordon’s case focused on a woman with worsening, widespread psoriasis who was considering becoming pregnant. What systemic psoriatic therapy might one choose in this scenario? Emphasizing that women with psoriasis already have a slightly higher risk of having a baby with a low birth weight or having a preterm birth, Dr Gordon posed this initial question: If a patient discovers that they are pregnant while on a biologic therapy, does the clinician continue therapy, switch to a different therapy, or take them off treatment? In the dermatology world, a prescriber is likely going to take pregnant patients off their biologics, really off all systemics, because these immune-driven inflammatory diseases tend to get better during pregnancy. Moreover, monoclonal antibodies do not begin crossing the placental barrier until approximately week 13 of gestation; once they do pass to the fetus, can they cause any anatomical or developmental damage? Limited registry data are available to help answer that question in women who decided to stay on their biologic medications during pregnancy. In general, clinicians take patients off biologics during pregnancy and refer/defer them to obstetrics-gynecology specialists. However, if the patient chooses to continue biologics during pregnancy, registry data support the safety of that approach. It was noted that certolizumab pegol has been proven to minimally cross the placental barrier and therefore could give one the greatest peace of mind as a continuous biologic pregnancy therapy.

 

Lastly, Dr Gordon focused on cardiovascular risk in patients with psoriasis. He discussed a 2006 study by Joel M. Gelfand, MD, MSCE, and colleagues, which was one of the first to examine this association. Researchers found that patients with severe psoriasis have a significantly higher risk of experiencing a myocardial infarction. Dr Gordon also discussed psoriatic patients who have greater than 10% body surface area (BSA) involvement vs those who have less than 10% BSA involvement. The studies indicated that patients with greater than 10% BSA involvement have a higher risk of developing cardiovascular disease. Finally, Dr Gordon emphasized that ongoing and recent data reveal that biologic therapies—not just TNF inhibitors but also anti–IL-17 and anti–IL-12/23 treatments—can potentially decrease the risk of cardiovascular disease in patients with psoriasis. Stay tuned!

References

Boskovic S, Borriello S, D’Ascenzo F, et al. Effectiveness of biological therapy in reducing psoriasis-related cardiovascular risk. Expert Opin Biol Ther. 2024;24(4):217-219. doi:10.1080/14712598.2024.2337242

 

Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80(4):1073-1113. doi:10.1016/j.jaad.2018.11.058

 

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296(14):1735-1741. doi:10.1001/jama.296.14.1735

 

Gordon K, Langley R. ADV: Challenging cases in the management of psoriasis. Session presented at: Society of Dermatology Physician Associates 22nd Annual Fall Dermatology Conference; November 13-17, 2024; Las Vegas, NV.

 

Palmeira P, Quinello C, Silveira-Lessa AL, Zago CA, Carneiro-Sampaio M. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol. 2012;2012:985646. doi:10.1155/2012/985646

 

Rahmati S, Moameri H, Mohammadi NM, et al. Impact of maternal psoriasis on adverse maternal and neonatal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):703. doi:10.1186/s12884-023-06006-5

 

Sánchez-García V, Hernández-Quiles R, de-Miguel-Balsa E, Giménez-Richarte Á, Ramos-Rincón JM, Belinchón-Romero I. Exposure to biologic therapy before and during pregnancy in patients with psoriasis: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023;37(10):1971-1990. doi:10.1111/jdv.19238

 

Vaengebjerg S, Skov L, Egeberg A, Loft ND. Prevalence, incidence, and risk of cancer in patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. JAMA Dermatol. 2020;156(4):421-429. doi:10.1001/jamadermatol.2020.0024

 

Wang S, Shin D, Garshick M, Gelfand J. Risk of cardiovascular disease based on objective measures of psoriasis severity: a prospective, population-based cohort study. J Am Acad Dermatol. 2024;91(3):AB82.

 

 

 

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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