The Role of Specialty Pharmacy in Boosting Psoriatic Arthritis Outcomes

Emerging therapies with unprecedented efficacy offer a promising future in the treatment of psoriatic arthritis (PsA), according to a continuing education session at the Asembia Specialty Pharmacy Summit 2017.

Presented by Pharmacy Times Continuing EducationTM, the session Supporting Specialty Pharmacies in Improving Care for Patients with Psoriasis and Psoriatic Arthritis, presented by Michael Crowe, PharmD, MBA, CSP, FMPA, senior manager of clinical services at Diplomat Specialty Pharmacy, explored optimal care for patients with PsA and the future implications of new biologic drugs for the disease.

“There are a number of new biologics coming to market for the treatment of psoriasis and psoriatic arthritis, some with novel mechanisms of action, some with efficacy we haven’t seen from the standard of care,” Crowe said. “The newest to market is a class of interleukin 17 inhibitors for psoriasis, many of which are seeking expanded indications for psoriatic arthritis. There is also the interleukin 23 inhibitor class, with outcomes in psoriatic arthritis that are very promising.”

Crowe noted during the session that psoriasis, one of the most common skin disorders worldwide, can affect nearly any part of the body. Patients may also develop scaling in painful silvery-white patches. In determining the appropriate treatment, disease severity is an important factor for providers.

Severity of disease is defined by the American Academy of Dermatology (AAD) based on the percent of body surface area (BSA) affected. Patients with psoriasis on less than 5% of their BSA have mild psoriasis, while those with greater than or equal to 5% BSA, but less than 10%, have moderate psoriasis. Having psoriasis greater than or equal to 10% BSA is considered severe.

“Treatment of psoriasis is usually a lifelong commitment; however, the specific treatment regimen may change from time to time depending on the pattern of exacerbations and remissions,” Crowe said. “The primary goal of treatment is skin normalization.”

A high proportion of patients with psoriasis may also have concomitant involvement in the joints, referred to as PsA, which is an inflammatory arthropathy associated with psoriasis, carrying symptoms such as joint pain, stiffness, and inflammation. Crowe said that anywhere from 6% to 42% of patients with psoriasis develop PsA, which can occur many years after the skin symptoms initially appear.

The severity of psoriasis and PsA, however, usually do not correlate with each other, according to Crowe. PsA can manifest with mild symptoms that are sometimes preceded by a joint injury. The course of PsA is unpredictable, and can vary from mild to severe and debilitating.

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