All Things Psoriasis With Dr. April Armstrong

Speaker 1 (00:00):

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Speaker 2 (00:32):

Welcome to the Practical Dermatology Podcast. This month, we have an interview with Dr. April Armstrong, and the latest news from around dermatology. Now, here's Dr. Neal Bhatia.

 Dr. Neal Bhatia (00:41):

Hi, this is Dr. Neal Bhatia. I'm Chief Medical Editor of Practical Dermatology, and this is another episode of the Practical Dermatology Podcast. I am pleased to do it with my good friend Dr. April Armstrong. April's probably the smartest person I know and the, the best dancer from the specialty, besides from many other things. She is also Professor and Chief of Dermatology at UCLA. And April, I want to pick your brain on psoriasis because I know it's one of your favorite subjects, but talk a little bit about just some of the research you're currently involved in, and where do you see things going from here?

 Dr. April Armstrong (01:14):

Great. Well, thank you Neal, and it's such a pleasure to be here with you today. So there are so many things to talk about. I will say currently, our group is working on epidemiologic studies to better understand comorbidities that are associated with some of our inflammatory skin diseases, so furthering in on HS and atopic dermatitis and psoriasis, of course, in those areas. I think there's just, so much more to be understood about the comorbidities that can be associated with these inflammatory skin diseases. We're also doing some independent studies looking at GLP-1 receptor agonists and their role in these different diseases, and if they have any independent effects aside from weight loss, of course, in our patients, and see how they could potentially help our patients suffering from these inflammatory diseases, with regards to either neural protection or also independent effects on the skin disease itself.

Dr. Neal Bhatia (02:15):

It's nice to see the approach not only looking at what's under the hood with the metabolic issues and everything else, but the other part is keeping diseases away, not just making them go away, which I think is also real important in the strategy. The other part of the equation, too, like you said about GLPs, I laugh because, you know, everyone was worried about needles and, you know, all of the impact of biologics, and yet everyone and their brother is on a GLP-1 agonist now. So talk about where do you see that fitting into dermatology now that, you know, some of the news is out?

Dr. April Armstrong (02:45):

Yes. I think it's actually critical to dermatology. As we know, we take care of diseases such as HS and psoriasis, and we know epidemiologically these patients have higher weight compared to patients who don't have these skin diseases. So reducing their metabolic risk is really important with these new innovations in anti-obesity therapies. So I think there's a lot to be learned in this area.

 Dr. Neal Bhatia (03:17):

And just real quick, I know we've talked about some of the drugs in development, the new oral 23, there's another interleukin-23, biologic, 17 A and F inhibitor coming. What are your thoughts on some of these early data points with some of those treatments in research?

Dr. April Armstrong (03:33):

Yeah, I think it's really exciting. I think that the next wave is probably the oral realm, which we can talk about a little bit more. I think when we're looking at the biologics, I feel that the field has really, we've got it in terms of the right targets, and now it's about how can we deliver that efficacy with fewer shots. And also thinking about in terms of how those biologics can be potentially incorporated earlier in the treatment journey.

Dr. Neal Bhatia (04:07):

And getting patients into the idea that, OK, maybe it was shorter numbers of shots per year or maybe with some better long-term safety data, we can get patients, you know, to take pills every day or at least thinking about rotating, you know, their treatments, which I think would be great. I want to switch your gear just for a second and talk about what you've done now. You've done a lot of leadership work with the IPC, the National Psoriasis Foundation, so many international initiatives. What has been your passion? Where do you see your drive and where does that leave you for what's next?

 Dr. April Armstrong (04:42):

Yes. So, I've done a lot of work with these wonderful organizations and through this, I think, it really highlighted to me the wonderful colleagues that I've worked with and how everyone works on the different piece of the larger puzzle. I think one of the things I recognize over time is that with these great innovations, getting those innovations to our patients is one of the most important aspects. So, that is one piece I'm very passionate about and working to try to make it better for our patients.

(05:17):

And number two is also just in terms of larger picture. And also Neal, you've had deep involvement with American Academy of Dermatology, and really helping to advocate for our dermatologists with regards to our ability to really run our practices and making sure that we can continue to maintain the care and augment the care that we have for our patients in that regard. So the good fight on the hill, but also in terms of making sure that we continue to define ourselves and educate ourselves with these new therapies so we can continue to really lead everyone in these endeavors.

Dr. Neal Bhatia (06:02):

Yeah. You brought up the initiatives on Capitol Hill, too, because every September we go to the legislative conference and you and I represent California and try to, you know, get our group to stump a little bit, which is great. Try to get Medicare back in line as well as some of the funding for research. And kind of leads me to my next question too. As a chief of a department and, you know someone who's heavily involved in clinical research, I mean, what part of trials in our current state do you see things going well and what would you like to see differently? What would you like to change if you, if you could take the screwdriver and change a few things around?

Dr. April Armstrong (06:37):

I think if I can take the screwdriver and change a few things around, it would be allowing patients to really be a part of clinical trials who are otherwise living really far away. Most of our trials require patients to come into our offices, as you know, Neal, to be a part of the clinical trial. Yet I feel that many of our patients can benefit from being a part of these newer innovations, but transportation is a key barrier actually to them. So thinking about in the future how federated clinical trials, remote clinical trials can be done, can really help, really ensuring that these opportunities are given to everyone.

Dr. Neal Bhatia (07:19):

We say, because you know, we live near the inland empires of California in the desert and patients who don't have access to care. And yet you wonder how many underserved patients there are, how many patients with large skin cancers that could be in a trial or, you know, head to toe psoriasis or eczema who aren't getting treated. So it does make that, you know, component of access at least, you know, from a remote aspect or at least making them eligible to be a subject in a trial, you know, that could, it could be a lot better. So I think that's real important.

(07:48):

The other part too, as an educator, I mean, you, as the chief of the department, I was a program director, we both know what it's like to make sure our youth are being treated, if you will, if you want to call them youth anymore, but I think we're facing a shortage of clinical researchers in the future. What do you see as far as trying to break that tide and bring more of our younger dermatologists into clinical trials?

Dr. April Armstrong (08:09):

Yeah, I think that's a great question. I think a part of it is just exposure to clinical trials during their training. I think many of our residents are very busy with their clinical responsibility. So oftentimes they may not have the opportunity or the bandwidth to be involved in clinical trials at that time. But I do think exposure early on is really important. Perhaps even before they become residents, for example, having some exposure would be very good.

(08:38):

And I think afterwards, it really about making sure that positioned actually in an area where you can actually recruit, because that is one of the key things I see. Younger faculty or derms who have just finished residency, where they're situated is actually very important with regards to the ability to recruit for these clinical trials. And just having an open mindset to be honest. If you have never done it before and you want to try it out, I think just having an open mindset, take on the trial that you think that you have the right population to recruit for, just take on one and then see how you like it and then can go from there.

Dr. Neal Bhatia (09:24):

Well said. And I think too that it's opening that door to the younger derms and make them a little bit more invigorated, might give them a boost in their career as we see all the changes in medicine, too. Well, April, thanks. I'm glad to steal a few minutes from you. I don't know anyone who works harder than you do, so thank you for spending a few minutes with me to talk and everything you've done for us and I appreciate it.

Dr. April Armstrong (09:47):

Thank you for having me, Neal.

Speaker 1 (09:49):

Every patient deserves to be seen. The TREMFYA Guselkumab photo library offers hundreds of real patient photos, easily filtered by patient characteristics, disease, locations, and severity. Learn more about TREMFYA for your patients at tremfyahcp.com.

Speaker 2 (10:13):

And now for the news. In our top story, Galderma's nemolizumab, which is branded as Nemluvio, was shown to have enduring impact in recent interim data from a long-term extension study in patients with atopic dermatitis. The ARCADIA trial included more than 19,000 patients with moderate to severe atopic dermatitis. The extension study looked specifically at the ongoing efficacy and safety of Nemluvio. The research team for the study presented two-year data during the recent revolutionizing atopic dermatitis meeting showing more than 85% of patients with atopic dermatitis achieving at least a 75% reduction in EASI-75 at 104 weeks. The study also reported significant reductions in itch severity showing 70% of patients treated with Nemluvio achieving nearly itch-free or itch-free status.

(10:57):

Study co-author Dr. Jonathan Silverberg, a Professor of Dermatology and Director of Clinical Research at the George Washington University School of Medicine told Practical Dermatology that these new long-term data reinforce Nemolizumab's sustained impact on both itch and skin clearance in patients with moderate to severe atopic dermatitis. Dr. Silverberg added that this offers meaningful evidence of a targeted therapy that can provide durable relief, which he said was essential for improving everyday quality of life for patients. Galderma received FDA approval for Nemluvio for the treatment of patients 12 years and older with atopic dermatitis in December. It is approved in the US for AD and prurigo nodularis.

(11:34):

New research suggests strontium cream may be a promising therapeutic option for the management of pruritus and hidradenitis suppurativa. A paper in the Journal of Clinical and Aesthetic Dermatology reported results from a 50-person study where participants completed baseline surveys and then applied strontium cream to areas of HS-affected pruritus for a period of 1 week. The results showed a significant reduction in pruritus post-application as well as significant reductions in itch scores compared to baseline. This study also reported that 84% of participants would recommend strontium cream to other HS patients. The authors called out strontium's ability to significantly reduce pruritus when added to a real-world treatment regimen.

(12:10):

Adding that strontium's multifaceted mechanisms, including the inhibition of nerve activity and reduction of inflammatory mediator release suggest it could be beneficial in alleviating HS-related pruritus. And finally, in the latest edition of Practical Dermatology's Atopic Dermatitis Journal Club series, Drs. Lisa Swanson and Peter Lio talk about a recent study in which dupilumab was linked with a reduced risk of atopic march in pediatric patients with atopic dermatitis. Here is a portion of that discussion.

Dr. Lisa Swanson (12:39):

We know that atopic dermatitis is associated with an increased risk of the atopic triad diagnoses like allergies and asthma, and it's more than a triad these days. There's now EoE and we also know that Dupilumab is an approved treatment for some of these things approved, for asthma down to 6, approved for EoE down to age 1. And what we're learning more recently is that early initiation of dupilumab for the atopic dermatitis might actually thwart the atopic march. I was so excited when I read this article. Peter, what did you think? Were your eyes wide open? Super jazzed?

Dr. Peter Lio (13:23):

A hundred percent. I mean, right. This is the dream if we could. So obviously curing the disease would be amazing, but preventing it would be even better. And this is the potential to prevent comorbidities that we know affect so many patients and have such a huge impact. And with a medicine that we already use and is already approved. It's one thing to hear about in the future, we're going understand these things. It's quite another for someone to say, “Hey, the thing that actually has been helping many of your patients might actually be doing more good. And frankly, it's refreshing to hear something good instead of, “It's also doing something terrible.”