Dr Cody Connor Discusses Treating Progressive Psoriasis

In this video, Cody Connor, MD, discusses how he approaches patients with psoriasis that has progressed and become more widespread. Dr Connor is a board-certified dermatologist practicing at Columbia Dermatology and Aesthetics in South Carolina.

Transcript

Dr Connor: Since we'd already tried Otezla, which is a great oral option, there's some of the other oral immunosuppressive medications like methotrexate or something like that. I think most of my patients, [and] I'm not trying to sell them on anything, but I can convince them that these newer biologic are just significantly more effective. They're safer. You don't have to worry about so many side effects, laboratory monitoring, that kind of stuff.

You also have to think about the poke that the patient's going to get when they're getting their labs checked, if they're on methotrexate. It's going to be just as many pokes potentially as if we get you on something where you're injecting yourself once every three months. I usually try to avoid those medicines if we can, just because I just think we have so many great options today that are safe and much more effective.

Typically, the situation I find myself in is, "OK. This insurance company is denying this specific biologic. They want us to try one of these other ones first." Like I mentioned earlier, I like the newer ones, the IL-23s, the 17s, because they do not block as much of the immune system as the TNF alpha inhibitors.

Of course, because that class of biologic has been around longer, a lot of the insurance companies say, "Oh, we'll cover Humira. You have to fail Humira first before you can move on to one of these other options." Typically, I will go ahead and try that if that's what is being required. A lot of these newer biologic companies have programs that will cover the medication for the patient, if they have commercial insurance and it's not covered. Sometimes you don't even really have to make that substitution.

You can do what you want just recognizing that the insurance is going to kind of be on the side, and the drug company is going to help out the patient.