IPC Jr. Councilor Towhida Noor reviews the psoriasis pipeline: selective TYK2 inhibitors, long-acting IL-17 and IL-23 biologics, and IL-36 blockade in GPP.
IPC Board Member and Treasurer Joel Gelfand, MD, MSCE, is the editor of a new textbook, Psoriasis: An Expert Global Perspective, now available for preorder from Elsevier. He worked with associate editors IPC President Bruce Strober, MD, PhD; IPC Vice President/President-Elect Claudia de la Cruz, MD; and IPC Chief Medical Officer Peter van de Kerkhof, MD, PhD. Nearly 50 authors from 20 countries contributed 30 chapters covering psoriasis from its earliest descriptions through genetics, immunology, and current therapies, with clinical images of psoriasis across diverse skin tones. All royalties support IPC.
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In this video, IPC Councilor Rodrigo Garcia Salinas, MD, a rheumatologist from Argentina, explains how to recognize psoriatic arthritis early, including why joint pain, how long a patient has had psoriasis, and family history can matter more than skin severity alone. He also reviews how imaging helps catch early disease and how to choose treatment based on each patient’s joint, spine, and skin involvement.
IPC President Bruce Strober reviews the link between psoriasis and metabolic disease, drawing on findings from IPC’s recent paper in the Journal of the American Academy of Dermatology (JAAD). He translates this growing body of evidence into five concrete priorities from the 2025 IPC Think Tank for improving cardiometabolic screening and care.
Commentary: Drug Survival Associated with Effectiveness and Safety of Treatment with Guselkumab, Ixekizumab, Secukinumab, Ustekinumab, and Adalimumab in Patients with Psoriasis
Alexander Egeberg, MD, PhD, DMSc
Bispebjerg Hospital
Copenhagen, Denmark
PUBLICATION
Drug Survival Associated with Effectiveness and Safety of Treatment with Guselkumab, Ixekizumab, Secukinumab, Ustekinumab, and Adalimumab in Patients with Psoriasis. Yiu ZZN, Becher G, Kirby B, et al. JAMA Dermatol. 2022 Jul 6:e222909. doi: 10.1001/jamadermatol.2022.2909. Epub ahead of print. PMID: 35791876; PMCID: PMC9260644.
Why this article was chosen
Real-world evidence studies become crucial to achieving the evidence needed in clinical practice. But how are data evaluated in the complexity of the real world?
Commentary
In recent years, clinical trials of drugs, such as interleukin (IL)-17 and IL-23 inhibitors, have shown remarkable levels of sustained long-term clearance of psoriasis. However, a fundamental limitation of clinical trials is that the patients included in such trials are not always representative of patients seen in daily clinical practice. Only about one-third of “real-life” patients are eligible for inclusion in a clinical trial. Moreover, comorbid diseases, physician behaviors, dose modifications, regional guidelines, payer policies, and prescribed co-medication may all influence the effectiveness and safety of biologics in daily clinical practice.
In daily practice, loss of response over time is often observed. Although the reasons are still not fully understood, this degree of “biologic fatigue” appears to differ between the different biologics. The term “drug survival” refers to the probability that a patient will remain on treatment and is a critical proxy measure of effectiveness in real-life settings.
The present study examined drug survival among 16,122 treatment courses of biologic therapy with either guselkumab, ixekizumab, secukinumab, ustekinumab, or adalimumab, using United Kingdom registry data. The authors found that guselkumab had the highest drug survival concerning effectiveness and safety. Notably, the authors also found that the effect of biologic therapy was modified by factors such as the presence of psoriatic arthritis, prior exposure to biologic therapy, current nail psoriasis, and ethnicity, thus highlighting that “one size does not fit all” when it comes to treating psoriasis.
Significantly, however, treatment patterns may change over time, and a patient is more likely to, e.g., discontinue adalimumab in the present day compared with twenty years ago, when alternatives were much more limited. The study adds to the growing list of real-world studies suggesting that novel biologics, such as the IL-23 inhibitor guselkumab, have a higher drug survival in psoriasis. Still, there remains an essential need for “personalized evidence,” i.e., predictors showing which patient profiles will benefit the most from a specific biologic.
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