How do you approach treatment change in patients with psoriasis who have been stable on an IL-17 or IL-23 agent but then begin to have breakthrough skin disease?
Do you first try adding topicals or UV? At what point do you decide to switch biologics and at that point do you try to class switch to a different MOA drug, or try another drug within the same class? Do you consider switching from IL-17A to IL-17A/F a class switch?
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How do you approach treatment change in patients with psoriasis who have been stable on an IL-23 agent but then begin to have breakthrough skin disease?
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3 Answers
Mednet MemberInvited Expert
Dermatology · University of Pennsylvania Perelman School of Medicine
Answered on
It really depends on where the patient is in their treatment journey. Patients who have tried and failed other biologics I try to optimize response by:
- increasing the biologic dosing frequency if insurance will allow,
- adding topicals, particularly newer ones like tapinarof or roflumilast,
- adding ph...
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Mednet MemberInvited Expert
Dermatology · Medical College of Wisconsin
Answered on
I would also add that is important to investigate for or address possible triggers that might resulting in the breakthrough disease such as new medications or infection (e.g. Strep).
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Mednet Member
Dermatology · Dept Dermatology Jefferson Medical College
Answered on
I'll add topicals or increase frequency of shots.
If that fails then switch to a different class of biologic.
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