Shared Decision-Making With Oral and Targeted Psoriasis Therapies

At the 3rd annual Dermatology Times Horizons in Advanced Practice meeting in Atlanta, Georgia, co-chair Douglas DiRuggiero, DMSc, MHS, PA-C, a physician assistant in Calhoun, Georgia, discussed the value of the meeting’s unbranded format, his presentation on psoriasis therapies, and the treatment developments he expects in 2027.

Unbranded Peer Exchange Across Experience Levels

Horizons in Advanced Practice brings together physician assistants and nurse practitioners who are new to practice, those with 2 to 5 years of experience, and others who have practiced longer. Sessions address disease states and all available products rather than a single therapy, as in a product theater. Attendees consider how to choose among options and which patients qualify for each.

“This is iron sharpening iron,” DiRuggiero said.

The discussion extends to communication. DiRuggiero said attendees compare how colleagues present data and options to patients. They also discuss how to approach a medical science liaison or representative to obtain data for use in the exam room.

“It’s hearing how other people present the data. How do you present options to them?” DiRuggiero said.

Oral and Targeted Therapies in Psoriasis

DiRuggiero presented alongside Lakshi Aldredge, MSN, ANP-BC, DCNP, FAANP, on oral and targeted therapies in psoriasis. He noted the door seemed closed on biologics, yet the class continues to push forward through studies raising the bar and additional joint indications. Oral peptides, such as icotrokinra, are now available as well.

He hopes attendees leave with greater confidence in managing patients and presenting options. Shared decision pathways, he said, should reflect comorbidities and prior therapy failures.

“I’m hoping what they’ll come away with is more confidence in managing these patients, more confidence in presenting the options to the patients, and more confidence in helping them make shared decision pathways based on their comorbidities,” DiRuggiero said.

Looking Ahead to 2027

DiRuggiero highlighted icotrokinra, the new oral peptide. He hopes upcoming data will include lower age groups and joint outcomes, and acknowledged both would be off label while trials continue. New TYK2 inhibitors and combination medicines in the monoclonal antibody space are also upcoming.

He pointed to the recent HS guidelines and growing research on targeted therapies in HS. He groups atopic dermatitis, HS, and psoriasis together within the auto-inflammatory pathway.

“We keep seeing the science open new avenues, open our minds to new pathways, and once a pathway is discovered, then they can develop a therapeutic to interrupt it,” DiRuggiero said.

DiRuggiero said he looks forward to new data and indications in the months ahead.

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