While many medications exist for the treatment of psoriasis, Dr Armstrong focused this lecture on the new and emerging therapies for this condition. She started with newly approved nonsteroidal topical medications, tapinarof and roflumilast. Interestingly, the former is derived from a species of bacteria within a roundworm with prominent anti-inflammatory properties, and patients treated with the cream demonstrated marked response that was even maintained for 24 weeks after stopping application. Dr Armstrong next reviewed the mechanism of action of deucravacitinib, the TYK2 inhibitor, which modulates the IL-23/IL-17 axis by binding to the more unique regulatory domain of the TYK2 molecule. Patients who obtained PASI75 or PASI90 by week 52 maintained response through an extension study of 3 years, and patients don’t require laboratory monitoring unless they have known liver or lipid disease. Novel IL-23 and IL-17 inhibitors are also under investigation.  

Bimekizumab is the newest approved biologic for psoriasis and has demonstrated fast onset and high efficacy with almost 70% of patients achieving a PASI100 by week 16 with noted improvement by week 4. Oral candidiasis is a known adverse event to be prepared for in patients on bimekizumab. She concluded by reviewing generalized pustular psoriasis, which has its first approved treatment with spesolimab. 

However, another important discussion launched by Dr Armstrong in the discussion of biologic medications is the clarification of biosimilars. They are defined as having identical therapeutic amino acid sequences relative to the reference product and must demonstrate biosimilarity in 3 features: pharmacokinetics, pharmacodynamics, and immunogenicity. She noted, however, that creating consistent identical copies of a biologic is nearly impossible, and dissimilarities exist even from batch to batch within the same manufacturer. Differences in biosimilars may be accounted for in delivery device, product concentration, or citrate content.