Expert dermatologists discuss how to select treatment for plaque psoriasis while taking comorbidities into consideration.
Mark G. Lebwohl, MD: Let me ask one more question, which is, do comorbidities influence your treatment decisions?
Alice B. Gottlieb, MD, PhD: The main reason if you’re a skin doctor, maybe arthritis and Crohn disease is considered a comorbidity. For the sake of argument, I think you’re talking about things like cardiovascular, comorbidities, and things like that. If you’re talking about that evidence-based medicine, because the TNF [tumor necrosis factor] blockers have been longer around, they’ve also been around in multiple indications, probably the strongest evidence for better cardiovascular outcomes is still with the TNF blockers. There is some evidence now with 1 of the IL [interleukin]-17 blockers that you may be decreasing cardiovascular risk. The answer is, yes, but it does influence me. The comorbidities that influence me more are psoriatic arthritis and inflammatory bowel disease. Sometimes patients will bring it up and then I will talk with them about it. I do use comorbidities as an argument when a patient doesn’t want a biologic because they’re scared of it or whatever the reason is. I say there’s a risk for not treating. Then I go into the inflammatory burden is not only bad for the joints and for the skin, [but] it could be potentially bad for the heart. And treatments that are not systemic will not touch that. I give that as an argument as more that you should treat the disease aggressively.
Mark G. Lebwohl, MD: Yes. I will say, I once was asked to speak to a large group of psoriasis patients—107 patients—and I asked them to stand up and I read a list of concomitant conditions that we consider when we decide which drug to use. I said, at the end of my reading the whole list I will ask you to sit down. It included things like psoriatic arthritis, risk factors for heart disease, obesity, hepatitis, HIV, lupus positive ANA. I went through the whole list. And at the end, I said, if I read anything that you have sit down. Out of 107 patients, only 1 was left standing. Comorbidities have a big impact on what we do.
Alice B. Gottlieb, MD, PhD: Right.
Transcript edited for clarity