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Drug Class Considerations for Patients With PP


Lauren Miller, MPAS, and Tj Chao, MPAS, discuss how patient goals and education can inform next steps of treatment for plaque psoriasis (PP).


Lauren Miller, MPAS, PA-C: If we talk about specific classes [of drugs], is there a reason why you might select 1 class over another?

TJ Chao, MPAS, PA-C: It comes down to what the patient is looking for, what risks they’re worried about, what they want to avoid, what they’re willing to do. It’s a decision between the patient and myself in regard to do whether they want to dose less frequently. Is cost a factor for them? How does that cost affect their decision-making? It’s a complex decision.

Lauren Miller, MPAS, PA-C: We look at lifestyle too, right?

TJ Chao, MPAS, PA-C: Right.

Lauren Miller, MPAS, PA-C: Do you break it down for them? Surprisingly, a large number of patients have moderate to severe disease but get only topical therapy. But do you break it down for them into the different therapeutic areas, like topicals, systemics, biologics? [Do you] go through all the options and then make a decision from that?

TJ Chao, MPAS, PA-C: Yes, I tell them all the options available. But I tell them how they’re going to respond to different therapies depending on what they think they’re going to select because that can have a huge influence on how they’re going to eventually respond.

Lauren Miller, MPAS, PA-C: Do you have patients who ask you what [you would] do?

TJ Chao, MPAS, PA-C: Oh, all the time. I’m very honest about that. I tend to pick therapies for patients that way. Now, it’s a different world we’re living in compared with 20 years ago. Our patients are more educated, but they also have a lot of exposure to misinformation on the internet. We have to deal with them looking things up beforehand. If they go on Google, what have they found?

Lauren Miller, MPAS, PA-C: OrTikTok.

TJ Chao, MPAS, PA-C: What have they heard on blogs, on TikTok, who knows? We have to work through all that.

Lauren Miller, MPAS, PA-C: They may have had a friend or family member who did a specific treatment and didn’t respond as well. So they’ll come in and say, “I don’t want to do that because I had a friend who didn’t do well on that.”

TJ Chao, MPAS, PA-C: The good news is that once you work through all that, the payoff for the patient in the long term is a lot better than it used to be. We’re going to get them to the better therapies that they deserve. And follow-up visits are going to be easier than that first visit up front.

Transcript edited for clarity.

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