Highlights from Fall Clinical

The end of October marked the 40th anniversary of the Fall Clinical Conference. Psoriasis and Psoriatic Arthritis highlights from the conference include:

COVID-19

• Dr. April Armstrong and Dr. Bruce Strober discussed information related to psoriasis management during the COVID-19 pandemic. This included the recommendation to not proactively discontinue medications and to emphasize the risk of stopping treatment in patients who want to stop. Biologics and cytokine inhibition were discussed, mentioning how IL17 and TNF inhibition may impede hyperinflammation. Data from a few studies all demonstrated that baseline use of biologics were not associated with worse COVID-19 outcomes nor did hospitalizations differ from the general population. Dr. Armstrong discussed the real-world outcome data, such as how IL23 inhibition in trials did not increase the risk of viral infections and are most likely safe. She also shared highlights from the NPF’s COVID-19 Taskforce Guidance Statements. These statements covered the effects of psoriatic disease on COVID-19, effects of Psoriatic disease treatment on COVID-19, what patients with Psoriatic disease should do if they become infected with COVID-19, and when patients with Psoriatic disease and COVID-19 should end home isolation.
• Dr. Kenneth Tomecki provided a COVID-19 vaccine update. He shared that there are 27 vaccines in Phase 1 testing, 14 in Phase 2, 11 in Phase 3, 5 vaccines approved for early or limited use, and 0 approved for full use. These vaccine candidates include genetic vaccines, viral vector vaccines, protein-based vaccines, inactive/attenuated vaccines and repurposed vaccines.

Psoriasis

• Dr. Armstrong presented information related to oral therapies for psoriasis, including current options and new opportunities. This presentation included information on methotrexate, apremilast, cyclosporine, acitretin, and deucravacitnib (in late-phase development). She reviewed how to use the treatments, necessary lab works and contraindications. Additionally, she discussed bone marrow suppression because of erroneous daily dosing of methotrexate and use of apremilast for oral ulcers associated with Behcet’s disease. As part of the Q & A session, Dr. Mark Lebwohl, Dr. Erin Boh and Dr. Strober joined Dr. Armstrong and continued the discussion. With regards to vaccinations, Dr. Armstrong discussed the CDC recommendations for patients receiving live vaccines prior to starting methotrexate or cyclosporine therapies. There is no guidance for apremilast, and Dr. Armstrong said she has not had patients schedule vaccines prior to starting treatment. Dr. Strober discussed deucravacitnib, mentioning that they will not know about necessary blood monitoring until the results of phase 3 clinical trial are released.
• Dr. Roger Ho discussed clinically important comorbidities, including psoriatic arthritis (PsA), cardiovascular disease, metabolic syndrome, mental health, and inflammatory bowel disease/hepatic disease. He highlighted the importance of appropriate patient education and the systemic inflammation nature of psoriasis. Additionally, he suggested screening for stronger associations, such as cardiovascular disease and depression.
• Dr. Gottlieb and Dr. Andrew Blauvelt discussed tildrakizumab. Dr. Gottlieb focusing on the safety and efficacy of tildrakizumab in PsA and in patients with/without metabolic syndrome. Dr. Blauvelt discussed the role of IL-23 cytokine in psoriasis, as well as the safety and durability of tildrakizumab. Additionally, he spoke about IL-17A versus IL-23 inhibition and the side effects, noting that IL-17A produced in the skin and gut by cells other than Th17 cells may protect from development of candidiasis and inflammatory bowel disease during treatment with IL-23 blockers. He also provided an overview of access to the treatment, noting tildrakizumab has favorable access in Medicare populations.

Psoriatic Arthritis

• Dr. Alice Gottlieb and Dr. Joseph Merola discussed PsA. This included a discussion on how dermatologists can be the first to detect arthritis, with some tips on recognizing, screening, and diagnosing. Information about screening included using the PEST tool and use of AAD-NPF guidelines on screening patients with psoriasis should be considered in all psoriasis patients and anyone who is suspected of possibly having PsA. Clinical clues in psoriasis can include scalp lesions, nail dystrophy, inverse intertriginous, family history, and/or severe disease in more than 2 sites. Enthesitis of the Achilles tendon, epicondyle, greater trochanter, and plantar fasciitis can be early features of PsA. Dr. Gottlieb also mentioned how the presence of PsA is independent of presenting psoriasis severity. Dr. Merola discussed telehealth for PsA and how to navigate the new landscape. He also shared that the Hands On App is a free app with many resources available, including a virtual experience for learning how to do a joint exam.

The recap is not intended to be a complete summation of all presentations. The captured information and data presented do not necessarily represent the beliefs of the National Psoriasis Foundation and are not intended to be promotional in nature.