All Things Considered in Psoriasis Management: Looking at the Role of Biologic Therapies in a Holistic Approach
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About This Presentation
Co-Chairs, April W. Armstrong, MD, MPH, and Andrew Blauvelt, MD, MBA, discuss psoriasis in this CME/CE/AAPA/IPCE activity titled “All Things Considered in Psoriasis Management: Looking at the Role of Biologic Therapies in a Holistic Approach.” For the full presentation, downloadable Practice Aid...
Slide Content
All Things Considered
in Psoriasis Management
Looking at the Role of Biologic Therapies
in a Holistic Approach
April W. Armstrong, MD, MPH Andrew Blauvelt, MD, MBA
Professor and Chief of Dermatology Consultant
University of California, Los Angeles Blauvelt Consulting, LLC
(UCLA) Lake Oswego, Oregon
Los Angeles, California
Copyright ©
in Psoriasis Management
Looking at the Role of Biologic Therapies
in a Holistic Approach
April W. Armstrong, MD, MPH Andrew Blauvelt, MD, MBA
Professor and Chief of Dermatology Consultant
University of California, Los Angeles Blauvelt Consulting, LLC
(UCLA) Lake Oswego, Oregon
Los Angeles, California
Copyright ©
Beneath the Surface
Unmet Needs and Opportunities
for Treating Psoriasis
April W. Armstrong, MD, MPH
Professor and Chief of Dermatology
University of California, Los Angeles (UCLA)
Los Angeles, California
Unmet Needs and Opportunities
for Treating Psoriasis
April W. Armstrong, MD, MPH
Professor and Chief of Dermatology
University of California, Los Angeles (UCLA)
Los Angeles, California
Our Goals for Today
Recognize that where psoriasis is on the body and the
impact on quality of life can affect the decision to use
systemic therapy
Understand the rationale for the use of biologics to prevent
psoriatic disease progression
Individualize treatment plans
Better engage in shared decision-making and team-based
care in psoriasis management
Copyright © 2000
Recognize that where psoriasis is on the body and the
impact on quality of life can affect the decision to use
systemic therapy
Understand the rationale for the use of biologics to prevent
psoriatic disease progression
Individualize treatment plans
Better engage in shared decision-making and team-based
care in psoriasis management
Copyright © 2000
Signs and Symptoms of Psoriasis’?
While patches of thickened, dry skin are common, psoriasis can have
many signs and symptoms and can vary by
+ Type of psoriasis present
+ Places psoriasis appears on the body
+ Percent BSA affected
+ Severity
+ Prevalence in Black people is 1.5% vs
3.6% in White people
than >7.5 million + Psoriasis is likely to be underdiagnosed
US adults among individuals with skin of color
because of differences in clinical
A me | presentation
| tps wer psoriasis orgabourpsorass. 2 ps: Ju aad orpipubliiseasessorasshhausymptons.
3 tos /dermnetnz o;gimagestchronieplaque-psorass mages. PeerView.com
Affects more:
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
While patches of thickened, dry skin are common, psoriasis can have
many signs and symptoms and can vary by
+ Type of psoriasis present
+ Places psoriasis appears on the body
+ Percent BSA affected
+ Severity
+ Prevalence in Black people is 1.5% vs
3.6% in White people
than >7.5 million + Psoriasis is likely to be underdiagnosed
US adults among individuals with skin of color
because of differences in clinical
A me | presentation
| tps wer psoriasis orgabourpsorass. 2 ps: Ju aad orpipubliiseasessorasshhausymptons.
3 tos /dermnetnz o;gimagestchronieplaque-psorass mages. PeerView.com
Affects more:
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Patients With Psoriasis Have High Disease Burden’
+ Poor self-image + Hopelessness
+ Avoidance of certain hobbies + Embarracement Eee
+ Lengthy morning routines + Stress + Lack of control
+ Changing careers + Anxiety + Depression
+ Working from home + Frustration
+ Continuous cleaning Activity Psychological
Impairment Impairment
Psoi
Family
Relationship
Impairment
Social
+ Stigma/discrimination impact
+ Secrecy to avoid disclosing
diagnosis to others
+ Avoid leaving the home
+ Social isolation
+ Lack of understanding
and support
4. Narayanan S et al. Psoriasis Auch). 20145:17. PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
+ Poor self-image + Hopelessness
+ Avoidance of certain hobbies + Embarracement Eee
+ Lengthy morning routines + Stress + Lack of control
+ Changing careers + Anxiety + Depression
+ Working from home + Frustration
+ Continuous cleaning Activity Psychological
Impairment Impairment
Psoi
Family
Relationship
Impairment
Social
+ Stigma/discrimination impact
+ Secrecy to avoid disclosing
diagnosis to others
+ Avoid leaving the home
+ Social isolation
+ Lack of understanding
and support
4. Narayanan S et al. Psoriasis Auch). 20145:17. PeerView.com
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Psoriasis Has a Significant Impact on Quality of Life!
= No effect on QOL (DLQI 0-1) m= Small (2-5) m Moderate (6-10) Very large (11-20) mExtremely large effect on QOL (21-30)
Effect on Patients’ QOL Impact on QOL Based on Current Disease Severity
) Mild (BSA of <5)
Moderate (BSA of 25 or <10)
I Severe (BSA of 210) | ER}
A. Armstrong AW etal, Dermatology. 2028-280:621-634. PeerView.com
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= No effect on QOL (DLQI 0-1) m= Small (2-5) m Moderate (6-10) Very large (11-20) mExtremely large effect on QOL (21-30)
Effect on Patients’ QOL Impact on QOL Based on Current Disease Severity
) Mild (BSA of <5)
Moderate (BSA of 25 or <10)
I Severe (BSA of 210) | ER}
A. Armstrong AW etal, Dermatology. 2028-280:621-634. PeerView.com
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Triggers and Modifiers of Psoriasis Symptoms’
Triggers
+ Infection
* Stress
Psoriasis Signs and Symptoms + Dry skin because of weather
Pl changes
f feng, * Certain medications
Pain/discomfort paume
Erythema
Skin flaking Modifiers
| + Effective treatment
+ Avoidance of triggers
+ Relaxation techniques
1.Narayanan S et al. Psoriasis Auch), 20145:17. PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, Peerview
Triggers
+ Infection
* Stress
Psoriasis Signs and Symptoms + Dry skin because of weather
Pl changes
f feng, * Certain medications
Pain/discomfort paume
Erythema
Skin flaking Modifiers
| + Effective treatment
+ Avoidance of triggers
+ Relaxation techniques
1.Narayanan S et al. Psoriasis Auch), 20145:17. PeerView.com
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Unmet Needs in Psoriasis
Nonresponse or
secondary loss Few effective
of response oral therapies
to many therapies
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Nonresponse or
secondary loss Few effective
of response oral therapies
to many therapies
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Moderate to Severe Psoriasis Remains
Persistently Untreated or Undertreated!
+ Nearly one-quarter of people with psoriasis have cases that are considered moderate to severe?
Topical Treatment by Level of BSA Involvement! Systemic Treatment by Level of BSA Involvement!
EE be oe
e 5
= x
0 70
8 60 * 60
ie [>
Eo ë 4
A A a ——
12% (>10 palms) to 29% (3 palms) of patients reported they 250% of patients with BSA >3 palms were receiving systemic therapy
were not currently receiving any treatment for their PSO (oral and/or biologic therapy) compared with 35% of those with <3 palms
a ze
3. Armstrong AW etal. JAMA Dermatol, 2021;157:940-946. 4. Lebwohl Metal. Dermatol Ther. 2022;12:61-78. PeerView.com
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Persistently Untreated or Undertreated!
+ Nearly one-quarter of people with psoriasis have cases that are considered moderate to severe?
Topical Treatment by Level of BSA Involvement! Systemic Treatment by Level of BSA Involvement!
EE be oe
e 5
= x
0 70
8 60 * 60
ie [>
Eo ë 4
A A a ——
12% (>10 palms) to 29% (3 palms) of patients reported they 250% of patients with BSA >3 palms were receiving systemic therapy
were not currently receiving any treatment for their PSO (oral and/or biologic therapy) compared with 35% of those with <3 palms
a ze
3. Armstrong AW etal. JAMA Dermatol, 2021;157:940-946. 4. Lebwohl Metal. Dermatol Ther. 2022;12:61-78. PeerView.com
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Also Undertreated: Patients With Limited Psoriasis
and Affected Special Areas!
+ On average, patients had two affected sensitive areas, despite 60% currently having mild psoriasis
M Overall MMild (BSA <5) Mi Moderate (BSA 25 to <10) M Severe (BSA 210)
sia 1007 0 100 1
so 2 2
Fi = 5
5 co | 55554 so Pr
E E
3 «0 Zo
» x 4 7
2 2 RTE 2
é E
ol
Scalp Face | Genitals Nails Soles Palms 21 Sensitive Area 22 Sensitive Areas 23 Sensitive Areas
Armstrong AW etal. Darmatolozy.2023299:821-894. PeerView.com
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and Affected Special Areas!
+ On average, patients had two affected sensitive areas, despite 60% currently having mild psoriasis
M Overall MMild (BSA <5) Mi Moderate (BSA 25 to <10) M Severe (BSA 210)
sia 1007 0 100 1
so 2 2
Fi = 5
5 co | 55554 so Pr
E E
3 «0 Zo
» x 4 7
2 2 RTE 2
é E
ol
Scalp Face | Genitals Nails Soles Palms 21 Sensitive Area 22 Sensitive Areas 23 Sensitive Areas
Armstrong AW etal. Darmatolozy.2023299:821-894. PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, Peerview
Psoriasis Severity Classification
+ Historically defined as as “mild,” “moderate,” and “severe”
+ Historical definitions of each vary, for example
Mild Moderate Severe
Trial populations <10% BSA 10%-20% BSA >20% BSA
ala aaa <3% BSA 3%-10% BSA >10% BSA
+ Typically, no considerations given for
— Impact on quality of life
— Involvement of special areas
— Past treatment failure(s)
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+ Historically defined as as “mild,” “moderate,” and “severe”
+ Historical definitions of each vary, for example
Mild Moderate Severe
Trial populations <10% BSA 10%-20% BSA >20% BSA
ala aaa <3% BSA 3%-10% BSA >10% BSA
+ Typically, no considerations given for
— Impact on quality of life
— Involvement of special areas
— Past treatment failure(s)
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Is This Mild, Moderate, or Severe Psoriasis?!
All four of these patients
have a total
BSA of 1% to 4%
1. Images courtesy of Dr, Andrew Blaue. PeerView.com
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All four of these patients
have a total
BSA of 1% to 4%
1. Images courtesy of Dr, Andrew Blaue. PeerView.com
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Special Areas Have a Substantial Impact on Quality of Life!
DLAI Total Score Categories by Special Area Involvement
1121-30 (extremely large effect) = 11-20 (very large effect) 6-10 (moderate effect) =2-5 (smalleffect) =0-1 (no effect)
100 1
1
90 1
1
& 1
70 i
® 1
zo 1
¿5 !
Es 1
70.3 1 475
3 ! atleast
2 | moderate
i effect
10 H
04 1
Scalp Palmsandorsoles Nails Genitals PsO (all)=1 PSO (all) without
special area Special area
involvement
n 1.016 1,930 889 602 442 2776 830
A. Leigh M et al Dermatol The. 2022:12:61-78. PeerView.com
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DLAI Total Score Categories by Special Area Involvement
1121-30 (extremely large effect) = 11-20 (very large effect) 6-10 (moderate effect) =2-5 (smalleffect) =0-1 (no effect)
100 1
1
90 1
1
& 1
70 i
® 1
zo 1
¿5 !
Es 1
70.3 1 475
3 ! atleast
2 | moderate
i effect
10 H
04 1
Scalp Palmsandorsoles Nails Genitals PsO (all)=1 PSO (all) without
special area Special area
involvement
n 1.016 1,930 889 602 442 2776 830
A. Leigh M et al Dermatol The. 2022:12:61-78. PeerView.com
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Effect on Quality of Life and Likelihood of Depression’
= No special locations
= Special locations
1. Blauve A et a. Psoriasis Peoriate Artt. 2023:8:100-106.
PeerView.com/GMW827
* 100
: an p< 00
€ 80
300 454 48
pa = | | |
5 20
¿1
Skin Moderate to Extreme Impact on QOL Skin No or Small Effect on QOL.
‘= No special locations = Special locations P< 001
x 100 208
Ge 732
$ 60
A 40 192 26.8
2 20
as — |
Depression Likely Depression Not Likely
PsO involving special
areas warrants
consideration of systemic
treatments usually
reserved for patients with
210% BSA involvement
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= No special locations
= Special locations
1. Blauve A et a. Psoriasis Peoriate Artt. 2023:8:100-106.
PeerView.com/GMW827
* 100
: an p< 00
€ 80
300 454 48
pa = | | |
5 20
¿1
Skin Moderate to Extreme Impact on QOL Skin No or Small Effect on QOL.
‘= No special locations = Special locations P< 001
x 100 208
Ge 732
$ 60
A 40 192 26.8
2 20
as — |
Depression Likely Depression Not Likely
PsO involving special
areas warrants
consideration of systemic
treatments usually
reserved for patients with
210% BSA involvement
PeerView.com
Copyright © 2000-2024, PeerView
Recategorization of Psoriasis Severity:
Delphi Consensus From the International Psoriasis Council!
Patients with psoriasis
Candidates Candidates
for systemic therapy
|=) meet at least one of the following criteria
1.BSA 210%
2. Disease involving special areas
3. Failure of topical therapy
4 Strober Bet al Am Acad Dernatal 2020:82:117-122 PeerView.com
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Delphi Consensus From the International Psoriasis Council!
Patients with psoriasis
Candidates Candidates
for systemic therapy
|=) meet at least one of the following criteria
1.BSA 210%
2. Disease involving special areas
3. Failure of topical therapy
4 Strober Bet al Am Acad Dernatal 2020:82:117-122 PeerView.com
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Coordinated Multidisciplinary Care in Psoriasis
Initiate the following efforts to build or improve on a coordinated care model
Offer training to the care team to increase awareness of PsO and PsA
to improve skills for diagnosis and management of these conditions
Implement care pathways that involve routine comorbidity screenings, personalized
patient education, and support with necessary patient behavior changes
Offer resources for medication affordability and telehealth to address
care-access challenges for underserved or lower-income populations
Create clear guidelines on when to refer patients to a specialist
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Initiate the following efforts to build or improve on a coordinated care model
Offer training to the care team to increase awareness of PsO and PsA
to improve skills for diagnosis and management of these conditions
Implement care pathways that involve routine comorbidity screenings, personalized
patient education, and support with necessary patient behavior changes
Offer resources for medication affordability and telehealth to address
care-access challenges for underserved or lower-income populations
Create clear guidelines on when to refer patients to a specialist
PeerView.com
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The Role of Advanced Practice Providers
in Psoriasis Management!
Relationship Building
+ Discuss short-term treatment goals + Engage with family and caregivers
+ Discuss good health and wellness habits — Discussion of sensitive topics
- Provide disease and treatment education
- Refer to patient support groups
Setting Reasonable Expectations
+ Explain benefits and risks of treatments + Discuss the need for long-term follow-up
+ Explain reasoning for treatment recommendations — Emphasize the importance of adherence
— Regularly assess patient satisfaction
Assessing Treatment Options
+ Assess severity of disease + Provide written treatment plans
+ Promote shared decision-making
— Consider access, cost, convenience, side effects,
and comorbidities
— Address fear of injections
1. Altredge LM, Young MS. J Dermatol Nurses Assoc. 2016;8:126. PeerView.com
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in Psoriasis Management!
Relationship Building
+ Discuss short-term treatment goals + Engage with family and caregivers
+ Discuss good health and wellness habits — Discussion of sensitive topics
- Provide disease and treatment education
- Refer to patient support groups
Setting Reasonable Expectations
+ Explain benefits and risks of treatments + Discuss the need for long-term follow-up
+ Explain reasoning for treatment recommendations — Emphasize the importance of adherence
— Regularly assess patient satisfaction
Assessing Treatment Options
+ Assess severity of disease + Provide written treatment plans
+ Promote shared decision-making
— Consider access, cost, convenience, side effects,
and comorbidities
— Address fear of injections
1. Altredge LM, Young MS. J Dermatol Nurses Assoc. 2016;8:126. PeerView.com
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Prioritizing Systemic Treatment
Pathophysiology of Psoriasis and Biologic
Interventions to Achieve Cutaneous Outcomes
Andrew Blauvelt, MD, MBA
Consultant
Blauvelt Consulting, LLC v=
Lake Oswego, Oregon -
Pathophysiology of Psoriasis and Biologic
Interventions to Achieve Cutaneous Outcomes
Andrew Blauvelt, MD, MBA
Consultant
Blauvelt Consulting, LLC v=
Lake Oswego, Oregon -
Key Features of the Immunopathogenesis of Psoriasis
Staphylococcus
Streptococcus @ © Candida Proinflammatory
IL-17 receptor cytokine production
TLR2 Den] (eg, TNF-a, IL-36)
Dendritic cell IL-A7A/IL-17F, Keratinocyte Antimicrobial peptide/
(and IL-22) activation chemokine production
TNF-« ©
Loar | OO
TNF-a Neutrophil
IL-36 ner > IL-17 receptor accumulation
cel -
(and IL-17A/
IL-17F)
Keratinocyte proliferation
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Staphylococcus
Streptococcus @ © Candida Proinflammatory
IL-17 receptor cytokine production
TLR2 Den] (eg, TNF-a, IL-36)
Dendritic cell IL-A7A/IL-17F, Keratinocyte Antimicrobial peptide/
(and IL-22) activation chemokine production
TNF-« ©
Loar | OO
TNF-a Neutrophil
IL-36 ner > IL-17 receptor accumulation
cel -
(and IL-17A/
IL-17F)
Keratinocyte proliferation
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Meta-Analysis:
Comparing Biologics and Oral Treatments for PsO!
Estimated Response Rates From the NMA of Short-Term PASI (Base Case)
+ 60 phase 2, 3, or 4 RCTS Treatuent. Bos
of FDA-approved and DRE
EMA-approved treatments Risankizumab, 150 mg 892869913)
for adults with moderate Ixekizumab, 80 mg 88.8 (86.5-90.9)
to severe psoriasis met Brodalumab, 210 mg 88.7 (86.5-90.8)
inclusion criteria Guselkumab, 100 mg 86.8 (83.8-89.4)
Se Secukinumab, 300 mg 831 (802-857)
Infiximab, 5 mg/kg 804 (76.5-84.0)
PASI 75, 90, and 100
spores rita a 10:16 Certolizumab pegol, 400 mg 71.4 (654-765)
weeks and 44-60 weeks On OL LEURS 697 (663-731)
from baseline mure 40 ma 69.5 (660-726)
+ Brodalumab, guselkumab, | Certolzumab pegol, 200 mg 652 (596-724)
ixekizumab, and Tildrakizumab, 200 mg 64.9 (594.703)
risankizumab were Tidrakizumab, 100 mg 622 (57.3-684)
associated with the highest Sr Kyl
short-term and long-term Er a AOL SAS)
PASI response rates Apremlast, 30 mg 308 268-350)
Dimethyl fumarate 29.6 (220-383)
1. Armstrong AW et al. JAMA Dermatol, 2020;186:258-260
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bo.
534859
PASI 90
71.6 (675-754)
70.8 (668-746)
70.6 (668-746)
67.3 (625-712)
614(572-656)
57.4 (522-628)
456 (393-522)
43.9 (402-479)
43.7 (40.0-47.4)
40.2 (835-472)
38.8 (333-447)
36.6 (31.4-425)
17.9 (14.9-21.4)
12109147)
1145-167)
111.013)
T Past100
40.4 (35.9-45.0)
39.5 (252-440)
39.2(352.43.9)
35.7 (30.9-40.7)
29.9 (26 3-339)
26.5 (223-314)
17.7 (138-223)
16.7 (144-193)
16.5(142-19.0)
144 (107-188)
136 (106-171)
12.5(97-158)
420,154)
241.831)
22(12:38)
0.1 (0.1.0.1
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Comparing Biologics and Oral Treatments for PsO!
Estimated Response Rates From the NMA of Short-Term PASI (Base Case)
+ 60 phase 2, 3, or 4 RCTS Treatuent. Bos
of FDA-approved and DRE
EMA-approved treatments Risankizumab, 150 mg 892869913)
for adults with moderate Ixekizumab, 80 mg 88.8 (86.5-90.9)
to severe psoriasis met Brodalumab, 210 mg 88.7 (86.5-90.8)
inclusion criteria Guselkumab, 100 mg 86.8 (83.8-89.4)
Se Secukinumab, 300 mg 831 (802-857)
Infiximab, 5 mg/kg 804 (76.5-84.0)
PASI 75, 90, and 100
spores rita a 10:16 Certolizumab pegol, 400 mg 71.4 (654-765)
weeks and 44-60 weeks On OL LEURS 697 (663-731)
from baseline mure 40 ma 69.5 (660-726)
+ Brodalumab, guselkumab, | Certolzumab pegol, 200 mg 652 (596-724)
ixekizumab, and Tildrakizumab, 200 mg 64.9 (594.703)
risankizumab were Tidrakizumab, 100 mg 622 (57.3-684)
associated with the highest Sr Kyl
short-term and long-term Er a AOL SAS)
PASI response rates Apremlast, 30 mg 308 268-350)
Dimethyl fumarate 29.6 (220-383)
1. Armstrong AW et al. JAMA Dermatol, 2020;186:258-260
PeerView.com/GMW827
bo.
534859
PASI 90
71.6 (675-754)
70.8 (668-746)
70.6 (668-746)
67.3 (625-712)
614(572-656)
57.4 (522-628)
456 (393-522)
43.9 (402-479)
43.7 (40.0-47.4)
40.2 (835-472)
38.8 (333-447)
36.6 (31.4-425)
17.9 (14.9-21.4)
12109147)
1145-167)
111.013)
T Past100
40.4 (35.9-45.0)
39.5 (252-440)
39.2(352.43.9)
35.7 (30.9-40.7)
29.9 (26 3-339)
26.5 (223-314)
17.7 (138-223)
16.7 (144-193)
16.5(142-19.0)
144 (107-188)
136 (106-171)
12.5(97-158)
420,154)
241.831)
22(12:38)
0.1 (0.1.0.1
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Ranking Efficacy: Many Analyses Showing Similar Results’
Cumulative Clinical Benefits of Biologics in the Treatment of Patients
With Moderate to Severe Psoriasis Over 1 Year: A Network Meta-Analysis
PASI 90
O 26 52 78 104 130 156 182 208 234 260 286 312 338 364
Cumulative Time of Response, d
4. Blawelt et al. Dormatol Thr (Heide). 2022:12:727-740.
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PASI 100
0 26 52 78 104 130 156 182 208 234 260 286 312 338 364
Cumulative Time of Response, d
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Cumulative Clinical Benefits of Biologics in the Treatment of Patients
With Moderate to Severe Psoriasis Over 1 Year: A Network Meta-Analysis
PASI 90
O 26 52 78 104 130 156 182 208 234 260 286 312 338 364
Cumulative Time of Response, d
4. Blawelt et al. Dormatol Thr (Heide). 2022:12:727-740.
PeerView.com/GMW827
PASI 100
0 26 52 78 104 130 156 182 208 234 260 286 312 338 364
Cumulative Time of Response, d
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Which Are the Safest Biologics for Psoriasis?
Prednisone, cyclosporine
Broad ine
Immune suppression
Partial
Immune modulation IL-23 blockers,
IL-17 blockers
Narrow
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Prednisone, cyclosporine
Broad ine
Immune suppression
Partial
Immune modulation IL-23 blockers,
IL-17 blockers
Narrow
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Recategorization of Psoriasis Severity:
Delphi Consensus From the International Psoriasis Council!
Patients with psoriasis
Candidates Candidates
for systemic therapy
|=) meet at least one of the following criteria
1.BSA 210%
2. Disease involving special areas
3. Failure of topical therapy
4 Strober Bet al Am Acad Dernatal 2020:82:117-122 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Delphi Consensus From the International Psoriasis Council!
Patients with psoriasis
Candidates Candidates
for systemic therapy
|=) meet at least one of the following criteria
1.BSA 210%
2. Disease involving special areas
3. Failure of topical therapy
4 Strober Bet al Am Acad Dernatal 2020:82:117-122 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Psoriasis Affects the Whole Person!
u
— > Psoriatic arthritis affects
approximately 30%
pa” cute, @) of people
have psoriasis
u A
aT
1. Elmets GA etal. J Am Acad Dermatol 2019,90:1073-11. PeerView.com
+ Increasing evidence supports the recognition of
psoriasis as a multisystem chronic inflammatory
disorder with multiple associated comorbidities
+ People who treat their psoriasis effectively may
also lower their risk of other comorbidities
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
u
— > Psoriatic arthritis affects
approximately 30%
pa” cute, @) of people
have psoriasis
u A
aT
1. Elmets GA etal. J Am Acad Dermatol 2019,90:1073-11. PeerView.com
+ Increasing evidence supports the recognition of
psoriasis as a multisystem chronic inflammatory
disorder with multiple associated comorbidities
+ People who treat their psoriasis effectively may
also lower their risk of other comorbidities
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Stages in the Progression of Psoriatic Disease?
Clinical/environmental risk factors
+ Obesity
+ Biomechanical stress
+ Infections (microbiome) H
Genetic factors 2 „| With asymptomatic
+ First-degree relative with PsA. synovio-entheseal
+ HLA-B27 allele inflation on imaging
Good outcome;
remission
PsA
with clinically
evident disease
(CASPAR
ir pores iasis 4 2 Poor outcome;
Skin andior immune sol
nail psoriasis activation with MSK symptoms damage
rthralgia,stifness)
ieee PsA sinus,
Y Y
Future treatment intervention Current treatment intervention
>
0-10 years
1. Pennington Sr, FtxGerald O. Front Med. 2024;0:723048, 2. Hiki T etal J Cl Med, 2022:1:2061, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Clinical/environmental risk factors
+ Obesity
+ Biomechanical stress
+ Infections (microbiome) H
Genetic factors 2 „| With asymptomatic
+ First-degree relative with PsA. synovio-entheseal
+ HLA-B27 allele inflation on imaging
Good outcome;
remission
PsA
with clinically
evident disease
(CASPAR
ir pores iasis 4 2 Poor outcome;
Skin andior immune sol
nail psoriasis activation with MSK symptoms damage
rthralgia,stifness)
ieee PsA sinus,
Y Y
Future treatment intervention Current treatment intervention
>
0-10 years
1. Pennington Sr, FtxGerald O. Front Med. 2024;0:723048, 2. Hiki T etal J Cl Med, 2022:1:2061, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Some Psoriasis Phenotypes Are Associated
With Greater Risk of Progression to PsA!-?
Intergluteal/
perianal lesions"
2.4x
Severe
disease”
2.2x
23 Affected sitesta
2.2x
Nail
dystrophy®
2.9x
Data reflect a study of 1,99 patients with psrisis, vi 57 diagnosed with new onset of Pak. Based on univaraie analysis. Data presented are hazard ratios.
ina cohort of 974 psoriasis patents (175 with confrmed PaA) at an academic medical center. Data presented are odds ratos
1. Pennington Sr, FtzGeral O. Front Med. 2021:8:723048. 2. Wison FC et al Ars Rhoum. 20081 233-230. 3. Yan D et al. Dermatol Ther. 2018.8:503-604,
4. Praccin BM, Starace M. Psoriasis (Auck). 2015:525-33. 5. Rendon A etal. Int J Mol Se. 201920-1475. 6. Chong HT etal. Biomed Res Int. 2013:2013:168321.
7. Glsondi Pet al Int J Mol Sel 2017.18:2427. 8. Photo crei Science Source.
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
With Greater Risk of Progression to PsA!-?
Intergluteal/
perianal lesions"
2.4x
Severe
disease”
2.2x
23 Affected sitesta
2.2x
Nail
dystrophy®
2.9x
Data reflect a study of 1,99 patients with psrisis, vi 57 diagnosed with new onset of Pak. Based on univaraie analysis. Data presented are hazard ratios.
ina cohort of 974 psoriasis patents (175 with confrmed PaA) at an academic medical center. Data presented are odds ratos
1. Pennington Sr, FtzGeral O. Front Med. 2021:8:723048. 2. Wison FC et al Ars Rhoum. 20081 233-230. 3. Yan D et al. Dermatol Ther. 2018.8:503-604,
4. Praccin BM, Starace M. Psoriasis (Auck). 2015:525-33. 5. Rendon A etal. Int J Mol Se. 201920-1475. 6. Chong HT etal. Biomed Res Int. 2013:2013:168321.
7. Glsondi Pet al Int J Mol Sel 2017.18:2427. 8. Photo crei Science Source.
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Two-Stage Transition for PsO to PsA
. PsO at higher risk for PSA Subclinical PsA New-onset clinical PSA
+ Early recognition
of PSA is crucial © © @
+ Diagnostic delay G&
of can lead to
— More severe
joint damage )
- Worse physical
funcion Medium/long-term risk Short-term risk factors
— Reduced chance factors for PsA (average for PSA (average of 1-3 y Swollen and
of therapeutic of 7-12 y before PsA onset) before PsA onset) tender joint
success
0 at higher risk for PsA
‘Severe skin involvement Arthralgia Poripheral pattern
Nail PsO Imaging evidence of Oligoarthritis pattern
synovio-entheseal inflammation
Obesity Articular erosions pattern
Familial history for PsA
4. Zaboti À tal. Ann Rheum Dis 2023;62:1162-1170 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
. PsO at higher risk for PSA Subclinical PsA New-onset clinical PSA
+ Early recognition
of PSA is crucial © © @
+ Diagnostic delay G&
of can lead to
— More severe
joint damage )
- Worse physical
funcion Medium/long-term risk Short-term risk factors
— Reduced chance factors for PsA (average for PSA (average of 1-3 y Swollen and
of therapeutic of 7-12 y before PsA onset) before PsA onset) tender joint
success
0 at higher risk for PsA
‘Severe skin involvement Arthralgia Poripheral pattern
Nail PsO Imaging evidence of Oligoarthritis pattern
synovio-entheseal inflammation
Obesity Articular erosions pattern
Familial history for PsA
4. Zaboti À tal. Ann Rheum Dis 2023;62:1162-1170 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Simple Questions to Assess for PsA
uf Do you have joint pain or swelling?
# Do you have heel pain?
uf Do you have back pain?
¥ Do you have morning stiffness lasting for more
than 30 minutes?
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
uf Do you have joint pain or swelling?
# Do you have heel pain?
uf Do you have back pain?
¥ Do you have morning stiffness lasting for more
than 30 minutes?
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Retrospective Studies Suggest That Biologic Treatment
of PsO May Reduce Risk of PsA‘?
+ 464 patients with moderate to severe PsO treated with biologics or phototherapy
over 25 years
— Biologic treatment was associated with a lower risk of incident PsA
(adjusted HR 0.27, 0.11-0.66)
+ 1,719 patients representing 14,721 patient-years received no treatment/topicals
(n = 1,387), conventional DMTs (n = 229), or biologics (n = 103)
— Risk of developing PsA in patients with PsO treated with biologics was significantly
lower (IRR = 0.26; 95% Cl, 0.03 to 0.94; P = .0111) vs topicals but not vs
conventional DMTs (IRR = 0.35; 95% Cl, 0.035 to 1.96; P = .1007)
+ In 15,501 patients with psoriasis, treatment with IL-12/IL-23 inhibitors or IL-23 inhibitors
was associated with reduced risk of progression to inflammatory arthritis compared
with treatment with TNF inhibitors
1. GiondiP et al Ann Rheum Dis. 2022 81:88:73. 2 Acosta Feuer ML et al, Ann Rheum Ds. 2022:31:7479 4
3.Singa S et al. Lancet Aneumato. 2023;5:e200-e207 PeerV
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
of PsO May Reduce Risk of PsA‘?
+ 464 patients with moderate to severe PsO treated with biologics or phototherapy
over 25 years
— Biologic treatment was associated with a lower risk of incident PsA
(adjusted HR 0.27, 0.11-0.66)
+ 1,719 patients representing 14,721 patient-years received no treatment/topicals
(n = 1,387), conventional DMTs (n = 229), or biologics (n = 103)
— Risk of developing PsA in patients with PsO treated with biologics was significantly
lower (IRR = 0.26; 95% Cl, 0.03 to 0.94; P = .0111) vs topicals but not vs
conventional DMTs (IRR = 0.35; 95% Cl, 0.035 to 1.96; P = .1007)
+ In 15,501 patients with psoriasis, treatment with IL-12/IL-23 inhibitors or IL-23 inhibitors
was associated with reduced risk of progression to inflammatory arthritis compared
with treatment with TNF inhibitors
1. GiondiP et al Ann Rheum Dis. 2022 81:88:73. 2 Acosta Feuer ML et al, Ann Rheum Ds. 2022:31:7479 4
3.Singa S et al. Lancet Aneumato. 2023;5:e200-e207 PeerV
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
UPLIFT: Patient Perceptions of Psoriatic Disease!
Web-based survey conducted March-June 2020 in North America, Europe, and Japan
Psoriasis
A A A A meg Psoriatic
arthritis
3,806 patients
50% female patients
Both
Findings: substantial patient burden, treatment dissatisfaction, and potential underuse
of systemic therapy in PsO, especially in patients with limited skin involvement,
involvement in special areas, or bothersome symptoms such as itching and pain
1.Lebewohl Met a. Dermatol Thor Heide). 202212:61-78, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Web-based survey conducted March-June 2020 in North America, Europe, and Japan
Psoriasis
A A A A meg Psoriatic
arthritis
3,806 patients
50% female patients
Both
Findings: substantial patient burden, treatment dissatisfaction, and potential underuse
of systemic therapy in PsO, especially in patients with limited skin involvement,
involvement in special areas, or bothersome symptoms such as itching and pain
1.Lebewohl Met a. Dermatol Thor Heide). 202212:61-78, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Living With vs Treating Psoriasis: UPLIFT Highlights
Opportunity to Improve Patient-C
Living With Vs Treating Psoria
nts
What factors define disease severity?
1. Type of symptom 1. Quality of life
2. Disease duration = 2. Amount of skin involvement
3. Lesion location ¡Fe 3 Type of symptoms
What is the most important treatment goal?
YY reduce itening Improve quaity ofife CB
What is the most important attribute of ideal therapy?
‘Symptom improvement x Long-term efficacy
Current treatment options
Patients find most options burdensome Doctors think 250% of patients are satisfied
D Topica 75%) À Ora(66%) D wis 62%) Moderate (59%)
WD Mniectea (84%) D severe (57%)
Are better therapies for psoriasis needed?
WD Yes (64%) À Yes (273%)
4. Lebewoh! Meta. Dermatol Ther Heide) 202212:61-78, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Opportunity to Improve Patient-C
Living With Vs Treating Psoria
nts
What factors define disease severity?
1. Type of symptom 1. Quality of life
2. Disease duration = 2. Amount of skin involvement
3. Lesion location ¡Fe 3 Type of symptoms
What is the most important treatment goal?
YY reduce itening Improve quaity ofife CB
What is the most important attribute of ideal therapy?
‘Symptom improvement x Long-term efficacy
Current treatment options
Patients find most options burdensome Doctors think 250% of patients are satisfied
D Topica 75%) À Ora(66%) D wis 62%) Moderate (59%)
WD Mniectea (84%) D severe (57%)
Are better therapies for psoriasis needed?
WD Yes (64%) À Yes (273%)
4. Lebewoh! Meta. Dermatol Ther Heide) 202212:61-78, PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Centering the Patient
Adapting Management Approaches
to Address Baseline Characteristics
and Challenging Manifestations
April W. Armstrong, MD, MPH Andrew Blauvelt, MD, MBA
Professor and Chief of Dermatology Consultant
University of California, Los Angeles Blauvelt Consulting, LLC
(UCLA) Lake Oswego, Oregon
Los Angeles, California
fh Sa!
Copyright
Adapting Management Approaches
to Address Baseline Characteristics
and Challenging Manifestations
April W. Armstrong, MD, MPH Andrew Blauvelt, MD, MBA
Professor and Chief of Dermatology Consultant
University of California, Los Angeles Blauvelt Consulting, LLC
(UCLA) Lake Oswego, Oregon
Los Angeles, California
fh Sa!
Copyright
Case Presentation ME
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scaly skin on many parts of his arms, legs, and scalp that have recently
become bothersome
Upon examination, pitting and onycholysis of the nails are also noted; no joint pain
How would you approach,
Q Diagnosis
Treatment
Monitoring the patient's psoriasis in clinical practice
Role of shared decision-making
Communication and collaboration among HCPs
PeerV
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scaly skin on many parts of his arms, legs, and scalp that have recently
become bothersome
Upon examination, pitting and onycholysis of the nails are also noted; no joint pain
How would you approach,
Q Diagnosis
Treatment
Monitoring the patient's psoriasis in clinical practice
Role of shared decision-making
Communication and collaboration among HCPs
PeerV
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Case Variation:
Patient With Skin of Color
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scal ain that have recently
become bothersq
Upon examinatid H; no joint pain
Would your management
How would you app approach change?
Q Diagnosis
Treatment
Monitoring the À
Role of shared det
Communication and collaboration among HCPs
If so, how?
PeerView.com
PeerView.com/GMW827 Copyrigh
Patient With Skin of Color
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scal ain that have recently
become bothersq
Upon examinatid H; no joint pain
Would your management
How would you app approach change?
Q Diagnosis
Treatment
Monitoring the À
Role of shared det
Communication and collaboration among HCPs
If so, how?
PeerView.com
PeerView.com/GMW827 Copyrigh
Topline Results From Phase 3b
of Guselkumab in People of Color’?
Preliminary findings from VISIBLE presented at Maui Derm 2024 — study of guselkumab
in skin of color participants with moderate-to-severe plaque and/or scalp psoriasis)
Assessment measures included PSSI, SSA, and ss-IGA
At week 16, patients experienced nearly 90% improvement from baseline after three doses of
guselkumab vs placebo (PSSI 100, 65.8% vs 3.8%; SSA, 86.6% vs 33.4%)
Complete scalp clearance was achieved in most patients receiving guselkumab vs placebo
(PSSI 100, 59.2% vs 3.8%; ss-IGA 0, 57.9% vs 3.8%)
Nearly 70% of of the guselkumab group achieved clinically meaningful improvements on the
Scalp Itch Numeric Rating Scale vs placebo (69.4% vs 24%)
No new safety signals were reported
VISIBLE study completion is anticipated in July 2025
1. Alesis A et al. Maul Derm Hawal 2024. Abstract. 2.htos Icinicalals gowstudyNCTO52721S0. 3. https www. dermatologytmes,comvewiguseikumab- n
slgnitcant-clearsscalppsorasi-n-patents-vityskinat-colorin-phase-3b-vsible PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
of Guselkumab in People of Color’?
Preliminary findings from VISIBLE presented at Maui Derm 2024 — study of guselkumab
in skin of color participants with moderate-to-severe plaque and/or scalp psoriasis)
Assessment measures included PSSI, SSA, and ss-IGA
At week 16, patients experienced nearly 90% improvement from baseline after three doses of
guselkumab vs placebo (PSSI 100, 65.8% vs 3.8%; SSA, 86.6% vs 33.4%)
Complete scalp clearance was achieved in most patients receiving guselkumab vs placebo
(PSSI 100, 59.2% vs 3.8%; ss-IGA 0, 57.9% vs 3.8%)
Nearly 70% of of the guselkumab group achieved clinically meaningful improvements on the
Scalp Itch Numeric Rating Scale vs placebo (69.4% vs 24%)
No new safety signals were reported
VISIBLE study completion is anticipated in July 2025
1. Alesis A et al. Maul Derm Hawal 2024. Abstract. 2.htos Icinicalals gowstudyNCTO52721S0. 3. https www. dermatologytmes,comvewiguseikumab- n
slgnitcant-clearsscalppsorasi-n-patents-vityskinat-colorin-phase-3b-vsible PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Case Variation:
Patient 270 Years of Age
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scal ain that have recently
become bothersq
Upon examinatid H; no joint pain
Would your management
How would you apq approach change?
Q Diagnosis
Treatment
Monitoring the À
Role of shared de
Communication and collaboration among HCPs
If so, how?
PeerView.com
PeerView.com/GMW827 Copyrigh
Patient 270 Years of Age
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scal ain that have recently
become bothersq
Upon examinatid H; no joint pain
Would your management
How would you apq approach change?
Q Diagnosis
Treatment
Monitoring the À
Role of shared de
Communication and collaboration among HCPs
If so, how?
PeerView.com
PeerView.com/GMW827 Copyrigh
Age as a Consideration When Selecting a Biologic'#
+ Older adults are under-represented in clinical trials of PsO treatments
— Excluded directly (upper age limits) or indirectly (due to age-associated
comorbidities)
+ Systematic review (31 papers, 39,561 patients with psoriasis) concluded:
“age should not be a limiting factor in its own right”
+ Six-center cohort safety study of conventional and biologic treatments in
patients 265 years
— Increasing age was associated with more causality-associated AEs
— Serious AEs were rare, mostly infectious, and reversible and/or manageable
— No association found between AEs and comorbidity, polypharmacy, or use
of a specific systemic therapy
1.Schaap ty eta.J Am Acad Dermatol. 202025412424. 2. van Winden MEC e a JAMA Dermatol. 2020;156:1229-1238, a
3.Ter Haar ELM ei al. Acta Derm Venero! 2022 102: 2412 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
+ Older adults are under-represented in clinical trials of PsO treatments
— Excluded directly (upper age limits) or indirectly (due to age-associated
comorbidities)
+ Systematic review (31 papers, 39,561 patients with psoriasis) concluded:
“age should not be a limiting factor in its own right”
+ Six-center cohort safety study of conventional and biologic treatments in
patients 265 years
— Increasing age was associated with more causality-associated AEs
— Serious AEs were rare, mostly infectious, and reversible and/or manageable
— No association found between AEs and comorbidity, polypharmacy, or use
of a specific systemic therapy
1.Schaap ty eta.J Am Acad Dermatol. 202025412424. 2. van Winden MEC e a JAMA Dermatol. 2020;156:1229-1238, a
3.Ter Haar ELM ei al. Acta Derm Venero! 2022 102: 2412 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Case Variation: Patient Is Pregnant 2
or Planning to Become Pregnant =
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scada that have recently
become bothersd
Upon examinatid we 7 5 A A; no joint pain
How would you app
Q Diagnosis
Treatment
Monitoring the À
Role of shared détiSIO MES
Communication and collaboration among HCPs
ew.com
Copyright © 2000-2024, PeerView
or Planning to Become Pregnant =
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scada that have recently
become bothersd
Upon examinatid we 7 5 A A; no joint pain
How would you app
Q Diagnosis
Treatment
Monitoring the À
Role of shared détiSIO MES
Communication and collaboration among HCPs
ew.com
Copyright © 2000-2024, PeerView
Case Variation: Patient Has a History of Cancer, ¿2
in Remission for 5 Years 8
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scalekiseemeeonmentenéhionenenlesenmnheelo that have recently
become bothersd
Upon examinatic 4; no joint pain
How would you apr
Q Diagnosis
Treatment
Monitoring the À
Role of shared decistureinaniiy
Communication and collaboration among HCPs
PeerView.com
Copyright O 2000-2024, Peerview
in Remission for 5 Years 8
A 47-year-old obese (BMI 33 kg/m?) male professional presents with plaques of
erythematous scalekiseemeeonmentenéhionenenlesenmnheelo that have recently
become bothersd
Upon examinatic 4; no joint pain
How would you apr
Q Diagnosis
Treatment
Monitoring the À
Role of shared decistureinaniiy
Communication and collaboration among HCPs
PeerView.com
Copyright O 2000-2024, Peerview
Implications of Cancer, Psoriasis, and Systemic Therapies’
+ Psoriasis is associated with elevated background risk of certain cancers, especially lymphomas
* Concerns have been raised about additive risk associated with biologic use, but safety reports on
TNF inhibitors, IL-17s, and IL-23s have been reassuring
+ No increased malignancy risk noted in association with ustekinumab use
+ Patients (N = 20) with newly diagnosed neoplasia and moderate to severe psoriasis had no tumor
recurrence or progression in 52 weeks of treatment with guselkumab
+ 5-year results from VOYAGE 1 and VOYAGE 2 trials of guselkumab (among the first studies of
biologics to include participants with a history of malignancy)
— Of 1,721 guselkumab-treated patients: 1 recurrence, 3 new malignancies (in men
270 years with prior malignancies)
1 Emets CA eta. J Am Acad Dermatol 2019: 80:1073-113 2 Menter et al. Am Acad Dermatol 2019:80-1029-1072
3. Gerson KB et al. J Am Acad Dermatol 2012:66:742-751. 4, Gracia Cazafa T et a. JAAD In. 2024:16:06-71 Las
5 Denaro N etal. In Mot Si 202324:17540. 6. Blauvel A etai. Br J Dermatol 2023:106:132:134 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
+ Psoriasis is associated with elevated background risk of certain cancers, especially lymphomas
* Concerns have been raised about additive risk associated with biologic use, but safety reports on
TNF inhibitors, IL-17s, and IL-23s have been reassuring
+ No increased malignancy risk noted in association with ustekinumab use
+ Patients (N = 20) with newly diagnosed neoplasia and moderate to severe psoriasis had no tumor
recurrence or progression in 52 weeks of treatment with guselkumab
+ 5-year results from VOYAGE 1 and VOYAGE 2 trials of guselkumab (among the first studies of
biologics to include participants with a history of malignancy)
— Of 1,721 guselkumab-treated patients: 1 recurrence, 3 new malignancies (in men
270 years with prior malignancies)
1 Emets CA eta. J Am Acad Dermatol 2019: 80:1073-113 2 Menter et al. Am Acad Dermatol 2019:80-1029-1072
3. Gerson KB et al. J Am Acad Dermatol 2012:66:742-751. 4, Gracia Cazafa T et a. JAAD In. 2024:16:06-71 Las
5 Denaro N etal. In Mot Si 202324:17540. 6. Blauvel A etai. Br J Dermatol 2023:106:132:134 PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
Summary
+ Psoriasis is a multisystem chronic inflammatory disorder with multiple
associated comorbidities
+ Psoriasis can substantially diminish patients’ quality of life, affecting
psychosocial well-being and activities of daily life
+ Systemic treatments should be considered for patients who have 210% BSA,
have involvement of special areas, or have failed topical therapy
+ Early systemic treatment may have a significant positive impact on the
long-term outcomes of psoriasis by delaying or preventing joint involvement
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
+ Psoriasis is a multisystem chronic inflammatory disorder with multiple
associated comorbidities
+ Psoriasis can substantially diminish patients’ quality of life, affecting
psychosocial well-being and activities of daily life
+ Systemic treatments should be considered for patients who have 210% BSA,
have involvement of special areas, or have failed topical therapy
+ Early systemic treatment may have a significant positive impact on the
long-term outcomes of psoriasis by delaying or preventing joint involvement
PeerView.com
PeerView.com/GMW827 Copyright © 2000-2024, PeerView
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