“Psoriasis is a chronic illness that poses a threat to life and bodily function,” said Cory Rubin, MD, FAAD, in lecture at the Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021. “Having the diagnosis of psoriasis increases the risk of heart attacks, stroke, early death, and numerous other things that don’t sound good if I had to tell you that that is you.”

In his presentation “Update on Psoriasis: Biologics, Biosimilars and Beyond,” Dr Rubin discussed the major factors to consider when prescribing a biologic and defined biosimilars.

Providers should note a few things with biologics:

• Approval (how long have they been out)

• Mechanism of action (MOA)

• Indications

• Dosing

• Molecular design

• Contraindications and precautions (what are the therapy side effects, and what will this do to me long term?)

Since 2004 with the FDA approval of etanercept, nine additional biologics have been approved for use. The biologics can be split into categories based on their MOA: tumor necrosis factor (TNF) α, interleukin (IL) 12/23, IL-23, IL-17A, and IL-17 receptor A. These different classes have various other indications, and these indications can ultimately influence what is prescribed. For example, said Dr Rubin, most of the available biologics are dual approved for psoriasis and psoriatic arthritis (those not approved are tildrakizumab, risankizumab, and brodalumab. Another example is other disease indications, such as hidradenitis suppurativa (adalimumab), rheumatoid arthritis (all TNF-α inhibitors, ixekizumab, secukinumab, and ustekinumab), and ulcerative colitis (adaliumamb, infliximab, and ustekinumab).

Patients may have preferences when it comes to the different components of dosing, including administration, schedule, and flexibility. Dermatologists should weigh whether a patient needs an in-office (a medical benefit) vs an at-home administration (a pharmacy benefit). The injection device can also be a patient choice, as some patients may prefer the “hidden injection” of a pen vs a syringe.

Dr Rubin stressed that patients are most concerned with the safety of biologics. “Has anyone ever told a patient the PASI score at week 16 because the patient asked about it? Well, me neither—what they care about is is this going to hurt me and what are the side effects?,” said Dr Rubin. Dermatologists should know that contraindications and safety precautions are going to be their patients’ biggest concerns and should be ready to discuss safety at length.

At the end of the session, Dr Rubin spent a few minutes lecturing about biosimilars. A common question, he said, is are biosimilars a generic for biologics?, adding that the short answer is no. Rather, Dr Rubin explained, these products are a biologic product “highly similar” to and with “no clinically meaningful differences” from an exisiting FDA-approved reference product, meaning a biosimilar has the same structure and safety, purity, and potency as its reference product. An interchangeable product is a biosimilar that meets additional requirements from the Biologics Price Competition and Innovation Act, and these can be used at will by a pharmacist. Dr Rubin added that providers should anticipate for the rapid addition of many biosimilars in 2023.