Interpreting Scalp and Nail Efficacy Data for Psoriasis Biologics

In "Interpreting Scalp and Nail Efficacy Data for Psoriasis Biologics," the panel follows this case to its resolution and what comes after starting therapy.

Given her busy, unpredictable shift schedule, the patient and her dermatologist decide on an HCP-administered biologic: tildrakizumab, the same IL-23-targeted agent used in Case 2, dosed every 12 weeks. She is able to schedule injections around her shifts, coordinating appointments either before or after work, which meaningfully improves her ability to stay on therapy consistently. Dr. Bunick asks Dr. Armstrong how she interprets scalp- and nail-specific efficacy data for tildrakizumab, secukinumab, and ustekinumab given this patient's high-impact site involvement.

Armstrong notes that scalp- and nail-specific data now exist for several biologics, which helps her set realistic expectations with patients even though head-to-head comparisons for these specific sites remain unavailable. She describes the overall data as encouraging, showing meaningful improvement across these therapies, and stresses that for patients with high-impact involvement she prioritizes agents that are both highly effective and specifically studied in these difficult areas. Dr. Bunick notes that psoriasis and psoriatic arthritis are fortunate to have more head-to-head trial data than many other inflammatory dermatologic conditions.

The discussion moves to ongoing monitoring after starting a biologic. Armstrong evaluates high-impact site involvement at follow-up, asks about injection difficulties and recent hospitalizations, and pays particular attention to tolerability issues like device problems or injection-site reactions during the first year of therapy. Longer term, she watches for waning efficacy and flags non-medical switching between biosimilars as a potential confounder when patients report new side effects. For patients experiencing breakthrough symptoms before their next dose, she prefers requesting a shortened dosing interval through the payer over increasing the per-dose amount, though she acknowledges payer approval for this is often difficult to secure, sometimes requiring peer-to-peer review or adjunctive topical therapy for stubborn plaques in the interim.

Up next, in "A Patient's Psoriasis Journey: From Topicals to Biologic Therapy," the panel welcomes patient Keki Mody to share his own three-decade experience with plaque psoriasis.