Psoriasis: Reaching for PASI 100

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Teaching science to practitioners in a way that’s “not so esoteric that your eyes glaze over” is a bit of a passion for Dr. Blauvelt. The objective is to help them understand the mechanism of action* in therapies, which will help them understand how it can tie into potential side effects a patient might experience, and ultimately help them find the right fit for their patients. In this case Dr. Blauvelt believes the right fit is doing what’s necessary to reach for 100% clearance of psoriasis for patients.

*In pharmacology, the term mechanism of action (MOA) refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect. A mechanism of action usually includes mention of the specific molecular targets to which the drug binds, such as an enzyme or receptor.

“I try to get my psoriasis patients to zero BSA (body surface area). I don’t thank that’s very common. We don’t see or hear that a lot. Patients often say that their last dermatologist said they were doing great at half better and pushed them out the door.” Dr. Blauvelt wants to make sure attendees understand that this is about the quality of life for the affected. “Patients with 90% improvement still have (a lower) quality of life than those with 100% clearance.”

“I try to get my psoriasis patients to zero BSA (body surface area). I don’t thank that’s very common. We don’t see or hear that a lot. Patients often say that their last dermatologist said they were doing great at half better and pushed them out the door.”

Certainly it’s easier to get to PASI 100 today than it was 5-6 years ago. Dr. Blauvelt cites the quality of todays treatments as a reason to be shooting for 100% clearance of Psoriasis. One potential roadblock he identifies is a fear of using biologics due to potential side-effects. “When a Dermatologist hears there is a one in fifty thousand chance of cancer they will avoid it. That same number won’t bother patients at all.”

Still, Dr. Blauvelt is careful to point out that PASI 100 isn’t always possible. “If the best you can do is move someone from horrible disease to manageable disease, everyone is going to be happy in the room. You have to learn to assess by the person on a case-by-case basis. Just don’t dismiss patients that want to be clear, and don’t assume they are happy if they are 50-60% better. It’s easier to get to PASI 100 than it was 5-6 years ago.”

“When a Dermatologist hears there is a one in fifty thousand chance of cancer they will avoid it. That same number won’t bother patients at all.”

Dr. Blauvelt also points out an overwhelming amount of data showing that patients are unhappy with dermatology care of psoriasis, a fact that could affect the bottom line for many. Or, as Dr. Blauvelt put it: “You don’t want the patient to be moving on from your practice. You can keep patients by using the best treatments available.”

DiseaseJonathan McClung