The 2022 IPC Think Tank scientific symposium was held on Friday, December 9th, in Miami, Florida. The meeting was held in a hybrid format with in-person and virtual attendees after two years of being virtual only due to the pandemic. Under the title, What’s Next in Psoriasis? From Maintenance to Disease Modification, the scientific day was organized into five sessions. The sessions encapsulated the current and future challenges with psoriasis management and provided interesting updates about disease modification, early treatment, personalized management, disease memory, biomarkers, and psoriasis diversity. You can download the full report or read on for a summary of the highlights.
DISEASE MODIFICATION OF PSORIASIS AND ITS COMORBIDITIES
- IPC Councilor Ken Gordon, MD, presented Efficacy of Biologics in Terms of True Disease Modification. He explained disease modification as altering the underlying pathophysiology to modify the disease course and decrease the long-term severity, morbidity, mortality, and cost. A critical factor for disease modification is enduring clinical benefits for patients. Potential domains of disease modification in psoriasis include changing the immune process or gene expression, prevention of comorbid diseases e.g. psoriatic arthritis, and improvement in the cumulative impact on the quality of life. It is suggested that biologic therapy can lead to some form of disease modification, but an accurate prospective analysis is needed.
- IPC Councilor Kevin Cooper, MD, presented Personalized Treatment in the Management of Comorbidities. He highlighted that some comorbidities of psoriasis are irreversible with permanent sequelae. Therefore, early detection and prevention of comorbidities are crucial for psoriasis patients. It is vital to predict at-risk patients by identifying psoriasis biomarkers. He suggested combining medical informatics with research laboratory informatics may help identify psoriasis endotypes and biomarkers.
PATHOMECHANISM OF DISEASE MEMORY IN PSORIASIS
- IPC Board Member Johann Gudjonsson, MD, PhD, presented What is Disease Memory in Psoriasis? He explained that the process of disease memory is probably responsible for the frequent relapse in psoriasis and the persistent changes recognized in non-lesional and/or resolved skin in psoriasis. On the molecular level, disease memory can be caused by the persistence of CD8+ tissue-resident memory T-cells (TRMs), particularly in the epidermis, that produce IL-17A and express high levels of IL-23R. In addition to TRMs, epigenetic modifications and chromatin changes seem to contribute to disease memory in psoriasis. These molecular pathways can provide a potential target for psoriasis therapy.
- IPC Board Member Andrew Blauvelt, MD, MBA, presented How to KNOCK OUT Disease Memory? He suggested that TRMs in psoriasis may be largely dependent on IL-23 for their survival. Therefore, IL-23 blockers can induce the longest disease-free intervals after stopping the drug. He reviewed part of his ongoing research work on Risankizumab. The work is based on the hypothesis that hitting hard and early in the treatment course of psoriasis with a high dose of IL-23 blockers may be an effective strategy to induce long-term remission and possible cure i.e., “knock out” therapy. The work may also have future implications to break away from established regular dosing patterns with the possibility of yearly dosing.
EARLY INTERVENTION AND DISEASE MODIFICATION
- IPC Honorary Founder Christopher Griffiths, OBE, MD, FRCP, FMedSci, presented Real-life Data on Early Intervention in Psoriasis. He emphasized that the first step for early treatment is early diagnosis. Therefore, it is crucial to facilitate the early diagnosis of psoriasis and provide patients with rapid access to specialized dermatology clinics. He discussed the importance of early intervention, i.e., a “proactive approach,” for disease modification and preventing comorbidities in psoriasis. He proposed that there is a rationale for discussing if biologic therapy should be introduced at early presentation for early intervention and disease modification.
- IPC Board Member Catherine Smith, MD, presented Biomarkers in the Long-term Management of Psoriasis. She explained that biomarkers could help resolve challenges with psoriasis management and reduce the lifetime burden of the disease. Biomarkers can detect disease susceptibility, help disease modification and prevention of comorbidities, and predict drug response and remission. A suitable biomarker should be cost-effective, impact the patient outcome, and have a societal impact. For efficient development of psoriasis biomarkers, Interdisciplinary efforts and collaborations are needed.
DIVERSITY AND PSORIASIS
- Andrew Alexis, MD, presented Skin of Color and Psoriasis, where he discussed the challenges met with the management of psoriasis in patients with skin of color. In skin of color, psoriasis has a lower prevalence, different clinical presentations, more tendency to develop post-inflammatory pigment changes, higher impact on quality of life, and unique treatment considerations. A characteristic “small plaque” type of psoriasis was described explicitly in Asians. The skin of color patients are also not well-presented in studies, particularly in biologics studies.
- IPC Board Member Jonathan Barker, MD, FRCP, presented Genetic Heterogenicity of Psoriasis. He explained that genetic variability accounts for 40-80% of psoriasis liability. Genome susceptibility in psoriasis is predominately involved in innate and adaptive immune responses. He highlighted that studying psoriasis genomes is important because drugs based on genetic mechanisms are more likely to proceed to approval in clinical trials. He proposed an interesting table for the stratification of psoriasis based on phenotypes, primary drivers, biomarkers, and likely treatment response, which you can review in the full report.
- IPC President Craig Leonardi, MD, presented A Vision of Long-term Management of Psoriasis, giving a general overview of psoriasis management. He provided a brief review of comorbidities focused on cardiovascular risk, a summary of treatments, ranking of biologic effects, and dealing with antidrug antibodies. Dr. Leonardi expressed his opinion that psoriasis treatment should not be strictly stepwise, and that the choice of therapy should depend on individual patient characteristics.
For a more in-depth read, please download the full report.