Access, Adherence, and Dosing Frequency in Older Psoriasis Patients

In "Access, Adherence, and Dosing Frequency in Older Psoriasis Patients," moderator and panelist weigh how injection frequency and site of care shape whether an older patient stays on therapy.

Returning to the 72-year-old patient, Dr. Bunick asks whether Dr. Armstrong would consider transitioning her to a biologic. Armstrong says she would weigh both oral and biologic therapies, but leans toward an infrequently dosed IL-23 inhibitor given the patient's hand osteoarthritis, since fewer required doses reduce her daily treatment burden and remove the need to remember an oral medication. Dr. Bunick raises a broader point about injections in older patients: many initially cringe at the idea, and some are simply unable to self-administer at home. He describes office-administered injections as valuable beyond the medication itself, since supervised administration builds patient confidence and often becomes a positive social touchpoint, with patients forming connections to nursing staff and feeling cared for during regular visits.

Armstrong agrees these visits are often genuinely enjoyable for patients, especially those with dexterity limitations or training needs. She raises an access point that shapes many treatment plans: for patients whose insurance coverage depends on Medicare Part B, office administration may be the only realistic path to an advanced systemic therapy. Bunick affirms that payer dynamics increasingly dictate which biologics are accessible, particularly for Medicare patients, and reiterates his focus on long-term compliance, floating quarterly, or Q12-week, dosing as especially valuable for older patients facing transportation or mobility barriers.

Armstrong adds that HCP-administered biologics are associated with greater persistence and adherence than self-administered options. She notes that patients are not limited to their prescribing physician's office; other centers of care closer to a patient's home can administer the same therapy, meaning geography need not become a barrier to consistent, adherent treatment over time.

The next episode in this series, "Real-World Persistence Data for IL-23 Biologics in Plaque Psoriasis," features Dr. Armstrong sharing real-world persistence data comparing tildrakizumab against other IL-23 biologics.