Psoriasis 2015: More Pearls from Bruce Strober, MD, PhD

  • Hepatitis B serologies should be obtained prior to starting TNF inhibitors. Understanding the meaning of the various tests is important.
  • Continuous therapy with biologics more reliably guarantees persistent response.
  • Palmoplantar psoriasis is usually more difficult to treat, yet most effective psoriasis medications can be successful in at least 1/3 of patients.
  • Subcutaneous methotrexate demonstrates better bioavailability, tolerability, and efficacy when compared to oral methotrexate.
  • Ustekinumab is approved for the signs and symptoms of psoriatic arthritis, yet displays lesser efficacy for this disease than that of the TNF inhibitors.
  • All biologics have demonstrated efficacy for the treatment of nail psoriasis.
  • It is safe to use TNF-inhibitors in the context of hepatitis C infection.
  • Immunogenicity is one reason biologic therapies lose efficacy over time.
  • Biologic therapies have not been demonstrated to cause solid tumor malignancies at a rate greater than the baseline rate of patients with psoriasis.
  • Patients with a prior history of malignancy often can safely receive biologic therapies.
  • Live vaccines should only be administered to patients who are not currently receiving biologic therapies.
  • TNF inhibitors are thought to be safe to use during pregnancy and breastfeeding.