Health Plan Best Practices in Psoriasis: Overcoming Access Barriers to Advanced Treatments

So this very complicated slide takes a really good stab at trying to think about the classes of biologics, one class or one kind of bucket of advanced systemic.

So you have your biologics, which mean that these are monoclonal antibodies.

These are proteins designed to target a signal that's being made in excess in psoriasis or the receiver for said signal.

What's not listed here, but we'll talk about, there are also what are called small molecule inhibitors, as the name infers.

They are teeny tiny, and they are designed to inhibit a protein machinery, usually inside the cell.

So these medications, they're big on a scale of things, on a cellular scale of things.

They work outside of the immune cells, where small molecule inhibitors, oral medications work inside the cell, for the most part.

That is changing a little bit.

And so you're seeing some of these comorbid diseases and classes of medications.

The acronyms you're seeing here are related to the actual names of the generic names of some of these medications.

There are kind of four broad classes.

There's a little overlap between two, but you have your TNF inhibitors, which are historic medications for which we do have now biosimilars as well.

We did just see our first IL-12 and 23 biosimilar come out for ustekinumab.

And then the later, I guess the more recent, I don't want to call them the new kids of the block, because they're certainly not at this point, but your IL-17 and IL-23 inhibitors, of which we have several, and they either go after the signal or in some cases may even go after the receiver, for example, for IL-17.

Why it's not listed for all of these is that, for example, for inflammatory bowel disease, there is some concern, but it is somewhat unfounded that IL-17 inhibitors might actually exacerbate inflammatory bowel disease.

So we try to avoid using in that setting.

And it's always nice to kill two birds or kill two birds, one stone, I think is the old one.

I think it's feed two birds with one scone is probably the more piece I see.

I see Susan's nodding her head.

You know, I think that, you know, kind of doubling down where some of these medications are approved for inflammatory bowel disease and psoriasis.

So if you have a patient with both or someone who might risk for one and has the other, that might be part of the consideration.

And then there's some contraindications when it comes to multiple sclerosis and TNF inhibitors that you have to think about as well, let alone pregnancy, where we technically have one that has it in the label, which is a pegylated TNF inhibitor that does not cross the placenta.

And there are studies to show that.

So I think that we're at a point where Some of the patient features might lead us down one way or another, which allows for shared decision-making and personalizing it, but we definitely still have some way to go.

On the left though, I wanted to include this because the GLP-1 agonists, certainly have made a tremendous splash in the world of medicine, not just dermatology, but specific to derm and even specific to psoriasis.