Dr. Alan Menter is an internationally renowned physician and researcher in the field of psoriasis. In addition to holding the title of Chairman of the Division of Dermatology at Baylor University Medical Center, Dr. Menter is also Immediate Past President of the International Psoriasis Council and frequently lectures at various national and international conferences. He has just returned from being President of the 3rd World Psoriasis & Psoriatic Arthritis Conference held in Stockholm, Sweden. Ahead, Dr. Menter shares insights on current psoriasis therapies, as well as how dermatologists can help to improve the disease's standing as a serious medical disease.
How would you assess the state of psoriasis therapy?
“It's a time of great excitement in the psoriasis world,” notes Dr. Menter. “Considering the history of psoriasis treatment, we have come a long way in the last decade. We have three TNFalpha inhibitors and more recently saw the approval of the first biologic agent designed specifically for psoriasis—ustekinumab [Stelara, Janssen].” With the activity of the last 10 years coupled with an array of potential innovations in the pipeline, Dr. Menter believes that psoriasis is at center stage in the realm of new drug development. “There are three anti-IL-17 agents currently under investigation, which are thus far showing excellent efficacy, as well as an oral molecule, tofacitinib (Pfizer) that has recently gained approval in rheumatoid arthritis.” Dr. Menter credits these advancements to the great strides achieved on the research front. “Recent data have ushered in new understanding of the immunopathogenesis of psoriasis and the role various pathways that have been explored recently,” Dr. Menter observes.
Despite many advances in systemic therapy, however, Dr. Menter observes that use of systemic agents remains “fairly flat.” This may speak to how psoriasis is perceived by dermatologists and non-dermatologists alike, notes Dr. Menter.
How can dermatologists help to shift the perception of psoriasis as a serious disease?
Roughly 10 years ago, research was undertaken to explore the associations of psoriasis and a variety of other conditions, Dr. Menter observes. Since then, the spectrum of comorbidities has expanded to include psoriatic joint disease, cardiovascular disease, diabetes, and others. “These findings may finally tip the scale to psoriasis being taken more seriously as an immunemediated disease,” says Dr. Menter. “The old theory held that if you get psoriasis at a young age, then you become obese and then are at an increased risk for cardiovascular and various other health conditions. However, there is now good data from the International Psoriasis Council that there may be a true metabolic reason for these associations with even young children and adolescents with psoriasis being heavier than their peers,” explains Dr. Menter.
In the broader context of healthcare, Dr. Menter wants to see psoriasis approached with an eye for comorbidities and an understanding that it is not merely a skin disease. “This means reaching out to our colleagues in primary care, who see and treat many psoriasis patients with moderate-to-severe disease,” says Dr. Menter. “While dermatology should be brought into the fold much sooner than perhaps it is in many cases, primary care physicians nevertheless require guidance about the nature of psoriasis, its coexistent disorders, and its full range of therapies.
What is the most rewarding aspect of treating patients with psoriasis?
“To see the change in a person's life whose psoriasis has for the first time cleared is incredibly satisfying,” notes Dr. Menter. “Psoriasis is one of the top three or four diagnoses dermatologists make in practice, and it is incumbent upon those in our field to understand the literature and the burdens these patients face,” he continues. “The question going forward will be how we measure psoriasis not only from a skin perspective but a medical perspective, as well as factoring quality of life issues.”
Fortunately, research continues to shed light on these issues. But regarding how clinicians can interact with patients, Dr. Menter's advice is to ensure that patients know that they don't have to live with their disease. “We are in a position as dermatologists to be actively impacting the lives of our patients, and we do that by educating patients, our colleagues, and ourselves.”