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Evidence Based Treatment Options for Plaque Psoriasis


Linda Stein Gold, MD, and Jennifer Soung, MD, provide an overview of the different, evidence-based topical strategies for treating plaque psoriasis.

LindaStein Gold, MD: Hello and welcome to Dermatology Times®’ “DermView Use of Nonsteroidal Treatment Options for Plaque Psoriasis.” My name is Linda Stein Gold, MD and I’m the director of dermatology clinical research at Henry Ford Health in Detroit, Michigan. I am thrilled to be joined by my friend and colleague, Dr Jennifer Song, MD. She joins us from Southern California Dermatology, where she is the director of dermatology clinical research. Welcome, Jennifer.

Jennifer Soung, MD: Thanks so much, Linda. Excited to be here.

LindaStein Gold, MD: We’re going to review nonsteroidal treatment options for patients with plaque psoriasis. As an overview, where we are right now in terms of topical therapy is that we have a number of topical agents, and there was a group of psoriasis experts who got together to publish the psoriasis treatment guidelines. For those guidelines, they scoured the literature for the best evidence-based medicine for the treatment topically of plaque psoriasis. It turns out there are just a few topicals that actually get the highest level of evidence. Those include topical corticosteroids; topical vitamin D analogs, such as cyclosporine; topical vitamin A such as Targretin; and the combination of steroid and vitamin D, or steroid and vitamin A. When we look at our options, especially our nonsteroidal options, these are commonly not used as monotherapy for plaque psoriasis because, for monotherapy, they haven’t been shown to be great heavy hitters. We worry about the irritation profile, and the good news is that we have 2 new FDA-approved nonsteroidal topical agents. The first one is roflumilast, and this is a topical phosphodiesterase 4 [PDE4] inhibitor. Jennifer, I know you’ve had experience with both of these new topicals. Can you tell us why we would use a PDE4 inhibitor for plaque psoriasis? We’ve seen it orally with apremilast, but why does that make sense?Let’s start with roflumilast and the topical PDE4 inhibitor.

Jennifer Soung, MD: We know that PDE4 works in terms of targeting psoriasis inflammation, but not all PDE4 inhibitors are the same. When I was an investigator and I started the clinical trials on topical roflumilast, I was [curious whether it] was going to work as a topical at all because we already had crisaborole, which wasn’t quite the most effective topical PDE4. As a target, I didn’t know if this was going to work at all, but in my own patients I was pleasantly surprised and it worked better than I thought because the PDE4 that roflumilast is targeting is different. It’s what I call a next-generation PDE4 because it’s up to 300 times more potent than crisaborole or apremilast. The oral formulation of roflumilast is FDA approved for COPD [chronic obstructive pulmonary disease] as well. So there’s an established safety profile.

Transcript edited for clarity

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