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?

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:

1. increasing the biologic dosing frequency if insurance will allow,
2. adding topicals, particularly newer ones like tapinarof or roflumilast,
3. adding ph...

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).

I'll add topicals or increase frequency of shots.

If that fails then switch to a different class of biologic.