A Patient's Psoriasis Journey: From Topicals to Biologic Therapy

In "A Patient's Psoriasis Journey: From Topicals to Biologic Therapy," the program shifts from panel discussion to a direct conversation with a patient living with plaque psoriasis.

The panel welcomes Keki Mody, an 83-year-old retired pharmaceutical executive and a patient of Dr. Bunick's, to share his firsthand experience with plaque psoriasis. Mody describes managing the disease for 20 to 30 years, initially with topical treatments including a corticosteroid-impregnated tape that produced remissions lasting months to years before symptoms inevitably returned. As his disease progressed in later years, spreading from his lower legs to his elbows, chest, and spine, topical management alone became inadequate.

Mody recounts his treatment history with Dr. Bunick in detail. Bunick initially recommended adalimumab, but Mody's rheumatologist flagged a concurrent diagnosis of MGUS as a reason to avoid that option, leading Bunick to prescribe secukinumab instead. Secukinumab worked quickly and cleared his skin after years of frustration, but a hospitalization for pancreatitis and gallbladder complications forced him to stop the medication, and his psoriasis returned in full force. Topical treatment alone proved only marginally effective afterward.

Bunick eventually identified tildrakizumab as an alternative, a decision shaped significantly by cost: earlier options were prohibitively expensive and poorly covered by insurance, while tildrakizumab was covered under Medicare Part B, resolving what had been a major financial barrier. Mody has now been on this therapy for roughly three years. He describes it as somewhat slower to take effect than secukinumab, but still highly effective, bringing his disease down to only minor, occasional breakthrough spots that resolve quickly with topical cream. His account illustrates how comorbidities, safety history, and insurance coverage can all reshape a treatment path over the course of decades, even when a patient's underlying disease remains fundamentally unchanged.

In "Patient Perspective: Cost, Comorbidities, and Dosing in Psoriasis Care," Keki Mody discusses how cost, comorbidities, and dosing frequency shaped his experience, along with his advice for other patients and clinicians.