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PP Treatment Selection: Best Practices


Experts offer insights on treatment selection and patient education for plaque psoriasis (PP).


Lauren Miller, MPAS, PA-C: Let’s get into the different drug classes. We have a ton of them, which is great. I love innovation, so this is wonderful. I’m going to guess we have a similar style in how we come up with our approaches. How do you find the right class of drug for your patients? Do you have a specific algorithm? We talked about looking at it like a big picture and putting all the puzzle pieces together, but can you give an overview of your approach?

TJ Chao, MPAS, PA-C: I dropped my use of algorithms a long time ago. My approach is to talk to the patient and try to understand what their goals are, what they want to accomplish in the treatment, and what they’re willing to do. That guides me as to what drugs to select for the patient. It’s important to educate the patients on the mechanism of action and explain to them why the medicine works the way it does. What are the effects? What are the benefits? What are the potential implications? It’s not a stair-step approach anymore. It’s just trying to decipher or figure out, putting the pieces of a puzzle together to try to decide what’s best for this patient in front of me.

Lauren Miller, MPAS, PA-C: Every patient is going to be different. You have to have that conversation with the patient and have them involved in the decision-making process. Our goal is to improve their quality of life and make them happy, and sometimes our idea of that is different from what their idea is.

I’m kind of greedy because I know that there are drugs that can get somebody 100% clear. But the things I’m worried about, they have no idea of. I’m worried about the long-term sequelae. I’m worried about the potential for psoriatic arthritis, heart disease, metabolic disease, depression, and things like that. It’s very important to sit down and have that conversation with patients. Some of these therapies that we have can improve these comorbidities in the patients. It’s also important to go over the pathogenesis of the disease. Most patients have never been told what they have, and they don’t know what it is. That’s important too. But I’m not necessarily [using] an algorithm because 1 patient might think something is severe based on the location, and another patient might think something is mild because it doesn’t bother them.

Transcript edited for clarity.

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