Biologics for Psoriasis and the Impact of the COVID-19 Pandemic

Aside from any rare decisions to modify treatment due to COVID-19 illness or risk for infection, did you see disruptions in medical treatment for psoriasis patients over the last 18 months?

Stefan Weiss, MD: I did not see any interruptions in care. Moreover, the pandemic highlighted the ease of telemedicine in managing psoriasis patients. My hope is that moving forward it will be more widely adopted to allow for patients with psoriasis (as well as AD) to obtain better, more regular care.

Jay Wu, MD: In the first few weeks of the pandemic, I think many patients and dermatologists stopped their patients from taking systemic therapy due to the unknown risks. However, with time, guidelines slowly came out that patients did not necessarily need to stop if they did not have any risk factors for COVID-19 infection.

What has been the overall impact of these disruptions? I had a few patients flare when their prior dermatologist told them to stop their biologic, but they cleared up again once they restarted that biologic under my care.

Bruce Strober, MD: My paradigm for psoriasis therapy was essentially unaltered during COVID-19. The “rules” around biologic and systemic therapies for psoriasis remained the same. We also kept our office open, and therefore access for our patients remained optimal.

Mostly, we had patients calling the office for clarification of how to alter their therapy in the setting of COVID-19. There were hundreds of these calls. My medical assistants were scripted in how to answer these inquiries. The greatest burden was related to patients who, without consulting us, unnecessarily discontinued their psoriasis therapies thinking it a safer approach. Consequently, some of these patients saw their psoriasis flare in severity and therefore needed unscheduled visits to “put out the fire.”

We know that stress can exacerbate psoriasis, and we have seen reports of increased stress and anxiety related to the COVID-19 pandemic. Have you seen an increase in demand for psoriasis treatment that may be tied to stress and anxiety? Are you seeing patients who are ready to “get out there” again who want psoriasis under control?

Dr. Wu: Yes, I’ve seen patients say they are ready for the pandemic lifestyle to end and want to get out there and socialize and mingle again, so they can’t have psoriasis in visible areas.

Dr. Strober: This is very hard to measure. I find most of my patients are already living under high stress (for example, I just saw a patient who lost her father and dog in the same month), so the effect of COVID-19 on this elevated baseline stress level is immeasurable.

I find all patients who come to see me, by definition, always want their psoriasis under control, all the time. There is no measurable difference from the past.

Dr. Weiss: I have not seen an increased demand. The demand for effective, easy-to-use treatments remains steady. Fortunately, there are many more of them, which serves patients well.

What has the experience of using biologics to treat psoriasis over the course of the pandemic revealed or reinforced about these treatments?

Dr. Strober: The therapies are safe, and their use likely leads to better outcomes for patients who become infected with SARS-CoV-2. Studies indicate that this might indeed be the case. In general, aside from their high cost, biologics overwhelmingly have a positive effect on society.

Dr. Wu: It has enforced that biologic therapies are the mainstay of treatment of moderate-to-severe psoriasis. However, if patients stop these therapies, they will flare and their quality of life will suffer.

Dr. Weiss: Patients on the newer agents are well controlled and able to be managed effectively by remote monitoring. It has been a real win for patients.

What developments do you most look forward to in terms of new/upgraded treatments for psoriasis over the next six to 12 months?

Dr. Weiss: I am hoping that remote patient monitoring will continue for this population. There are several new oral and injectable agents on the horizon, which will open up more options for patients with PsO and PsA.

Dr. Wu: Bimekizumab will be approved by the end of 2021, and that will likely take the title of “most effective biologic” for psoriasis. It is also in development for psoriatic arthritis as well.

Dr. Strober: Deucravacitinib (TYK2 inhibitor, not a biologic), bimekizumab (IL-17 A and F inhibitor), and the topicals tapinarof and roflumilast (not biologics).

All four drugs will alter the treatment landscape. Further, secukinumab will obtain “tailored” dosing (every two weeks) for patients who are heavier.