PracticalDermatology

Dr. Alexa Boer Kimball is Vice Chair of the Department of Dermatology at Massachusetts General, where she is also Senior Vice President of the Physicians Organization and Director of the Clinical Unit for Research Trials in Skin. With vast research experience, Dr. Kimball is particularly recognized for her work on psoriasis, having authored numerous articles for publications such as Archives of Dermatology, Arthritis and Rheumatism, British Journal of Dermatology, as well as The Lancet and JAMA. Dr Kimball has also served as associate editor for the “Clinical Trials and Therapeutics” section of the Journal of the American Academy of Dermatology and a medical editor for the “Dermatology” section of eMedicine. Ahead, Dr. Kimball reflects on the current shape of psoriasis care and the role that biologics will continue to play going forward.

How would you characterize the current state of treatment of psoriasis, particularly as biologic agents are concerned?

“It is truly remarkable to think of how far we have come; it was only 15 to 20 years ago that many of our patients spent weeks of their lives in our treatment facilities to keep their disease under control,” says Dr. Kimball. “Now, for our moderate-to-severe patients, we have around 10 treatment options ranging from improved light to conventional systemics to biologics.” She expects that more options will be available before long, as well, with the potential addition of new oral therapies to the market in coming years. With a bevy of available options, psoriasis patients may hopefully be able to live with less intrusion from their disease. “People feel better, they can return to work and family priorities and in many cases, therapy is minimally disruptive to their lives,” Dr. Kimball observes.

With the growing spectrum and classes of biologic agents, what is the latest data telling us about the utility of different types of biologics, and what would you like to see emphasized in ongoing and future research?

“Now that we have a number of choices, and several more coming down the pipeline, we’ll need to continue to work on how to determine which therapies are most likely to work for which patients and how to minimize the risks of losing efficacy,” Dr. Kimball says. “Of course, long-term safety data is critically important and we are making substantial progress in that area as well with registries and database analyses.”

Given that biologic use in the US is still not particularly high in psoriasis, do you have any advice for your fellow dermatologists when it comes to prescribing and administering these agents?

“Experience does help in using these medications, which is why those of us who do a number of clinical trials are often the early adopters of the biologics and other new medications,” Dr. Kimball observes. But familiarization has to start somewhere, and Dr. Kimball suggests that biologic agents are not as intimidating as they might appear from the outside. “In reality, the biologics are pretty easy to use. Some of my shortest follow-up visits are my well-controlled patients on stable doses,” says Dr. Kimball. She also notes that these patients often feel well and are pleased with their improvement, while the safety monitoring is often straightforward.

With so many recent innovations and continued safety and efficacy data to support their use, Dr. Kimball believes that biologics will continue to play an important role in the treatment of moderate-to-severe psoriasis. But she also acknowledges that there are barriers to insurance authorization and cost that pose difficulties with using biologics. “We will have to continue to advocate for reasonable pricing and continued access to these drugs for our patients,” Dr. Kimball asserts.