insurance company to approve their new biologic; while waiting
for an insurance company to approve a new biologic, patients
continue to suffer from their residual psoriasis. Navigating
through new insurance paperwork, when switching from a drug
that was already authorized to a new one, also entails greater
cost to the physician’s practice, a cost that we did not include in
our model. A limitation in this study is that the estimate of cost
for switching a biologic may be low as failing one drug may
make it more likely patients would fail a second one.
CONCLUSION
Adding a topical agent may be an effective, low cost, and safe
approach to achieve clearing in patients with psoriasis who fail
to achieve complete clearance from an initial biologic.
DISCLOSURES
This study received a research grant from LEO Pharma Inc. Dr.
Steven Feldman has received research, speaking and/or consulting
support from a variety of companies including Galderma,
GSK/Stiefel, Almirall, LEO Pharma, Boehringer Ingelheim,
Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly,
Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient,
National Biological Corporation, Caremark, Advance Medical,
Sun Pharma, Suncare Research, Informa, UpToDate, and National
Psoriasis Foundation. He is founder and majority owner
of www.DrScore.com and founder and part owner of Causa Research,
a company dedicated to enhancing patients’ adherence
to treatment.
Wasim Haidari and Dr. Adrian Pona have no conflicts to disclose.
REFERENCES
1. Rapp SR, Feldman SR, Exum M, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 2017;41(3):401-407.
2. Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol. 1999;76(3):377-390.
3. Smith J, Cline A, Feldman SR. Advances in Psoriasis. South Med J. 2017;110(1):65-75.
4. Hu Y, Chen Z, Gong Y, Shi Y. A Review of Switching Biologic Agents in the Treatment of Moderate-to-Severe Plaque Psoriasis. Clin Drug Investig. 2018;38(3):191-199.
5. Strober B, Papp KA, Lebwohl M, et al. Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol. 2016;75(1):77-82 e77.
6. Mrowietz U, de Jong EM, Kragballe K, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2014;28(4):438-453.
7. Kerdel F, Zaiac M. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals. Dermatol Ther. 2015;28:390-403.
8. Shahwan KT, Kimball AB. Managing the dose escalation of biologics in an era of cost containment: the need for a rational strategy. Int J Womens Dermatol. 2016;2(4):151-153.
9. Medi-Span Price Rx. Third-party provider of drug pricing information. Accessed 03/15/2019.
10. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019.
11. Menter A, Tyring SK, Gordon K, et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol. 2008;58(1):106-115.
12. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis:52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). The Lancet. 2008;371(9625):1675-1684.
13. Gordon KB, Blauvelt A, Papp KA, et al. Phase 3 trials of ixekizumab in moderate- to-severe plaque psoriasis. N Engl J Med. 2016;375(4):345-356.
14. Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparatorcontrolled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405-417.
15. Gottlieb AB, Kalb RE, Blauvelt A, et al. The efficacy and safety of infliximab in patients with plaque psoriasis who had an inadequate response to etanercept: results of a prospective, multicenter, open-label study. J Am Acad Dermatol. 2012;67(4):642-650.
16. Langley RG, Tsai TF, Flavin S, et al. Efficacy and safety of guselkumab in patients with psoriasis who have an inadequate response to ustekinumab: results of the randomized, double-blind, phase III NAVIGATE trial. Br J Dermatol. 2018;178(1):114-123.
17. Bagel J, Zapata J, et al. A prospective, open-label study evaluating adjunstive calcipotriene 0.005%/betamethasone dipropionate 0.064% foam in psoriasis patients with inadequate response to biologic therapy. J Drugs Dermatol. 2018;17(8):845-850.
18. Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16(12):1209-1222.
19. Mrowietz U, Bachelez H, Burden AD, et al. Secukinumab for moderate to severe palmoplantar pustular psoriasis: Results of the 2PRECISE study. J Am Acad Dermatol. 2019;80(5):1344-1352.
20. Strohal R, Chimenti S, et al. Etanercept provides an effective, safe and flexible short- and long-term treatment regimen for moderate-to-severe psoriasis: a systematic review of current evidence. J Dermatolog Treat. 2013; 24(3):199-208.
2. Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol. 1999;76(3):377-390.
3. Smith J, Cline A, Feldman SR. Advances in Psoriasis. South Med J. 2017;110(1):65-75.
4. Hu Y, Chen Z, Gong Y, Shi Y. A Review of Switching Biologic Agents in the Treatment of Moderate-to-Severe Plaque Psoriasis. Clin Drug Investig. 2018;38(3):191-199.
5. Strober B, Papp KA, Lebwohl M, et al. Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol. 2016;75(1):77-82 e77.
6. Mrowietz U, de Jong EM, Kragballe K, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2014;28(4):438-453.
7. Kerdel F, Zaiac M. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals. Dermatol Ther. 2015;28:390-403.
8. Shahwan KT, Kimball AB. Managing the dose escalation of biologics in an era of cost containment: the need for a rational strategy. Int J Womens Dermatol. 2016;2(4):151-153.
9. Medi-Span Price Rx. Third-party provider of drug pricing information. Accessed 03/15/2019.
10. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019.
11. Menter A, Tyring SK, Gordon K, et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol. 2008;58(1):106-115.
12. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis:52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). The Lancet. 2008;371(9625):1675-1684.
13. Gordon KB, Blauvelt A, Papp KA, et al. Phase 3 trials of ixekizumab in moderate- to-severe plaque psoriasis. N Engl J Med. 2016;375(4):345-356.
14. Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparatorcontrolled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405-417.
15. Gottlieb AB, Kalb RE, Blauvelt A, et al. The efficacy and safety of infliximab in patients with plaque psoriasis who had an inadequate response to etanercept: results of a prospective, multicenter, open-label study. J Am Acad Dermatol. 2012;67(4):642-650.
16. Langley RG, Tsai TF, Flavin S, et al. Efficacy and safety of guselkumab in patients with psoriasis who have an inadequate response to ustekinumab: results of the randomized, double-blind, phase III NAVIGATE trial. Br J Dermatol. 2018;178(1):114-123.
17. Bagel J, Zapata J, et al. A prospective, open-label study evaluating adjunstive calcipotriene 0.005%/betamethasone dipropionate 0.064% foam in psoriasis patients with inadequate response to biologic therapy. J Drugs Dermatol. 2018;17(8):845-850.
18. Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16(12):1209-1222.
19. Mrowietz U, Bachelez H, Burden AD, et al. Secukinumab for moderate to severe palmoplantar pustular psoriasis: Results of the 2PRECISE study. J Am Acad Dermatol. 2019;80(5):1344-1352.
20. Strohal R, Chimenti S, et al. Etanercept provides an effective, safe and flexible short- and long-term treatment regimen for moderate-to-severe psoriasis: a systematic review of current evidence. J Dermatolog Treat. 2013; 24(3):199-208.
AUTHOR CORRESPONDENCE
Wasim Haidari BS BA wh374@georgetown.edu
