Biologics are safe: Speaker reviews management during COVID-19, treatment pipeline
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Despite the obstacles caused by insurance companies and the pandemic, patients can still be safely managed with biologics. Bimekizumab, a treatment in the pipeline, could reduce burden and improve outcomes in psoriasis, a speaker said.
During COVID-19, “unfortunately, we have to change a lot of practices — the way we practice, the way we see patients — but the basics are the same,” Leon H. Kircik, MD, said during a presentation at the virtual South Beach Symposium Medical Dermatology Summit.
“There are so many questions, concerns [and] thoughts about biologics,” he said, but emphasized that biologics are “safe and safe and safe.”
Bimekizumab, an IL-17A and IL-17F blocker, is one promising treatment in the pipeline. It had superior efficacy to ustekinumab in a phase 3 trial, with 76.9% of patients achieving PASI 75 at week 4 (vs. 15.3% for ustekinumab) and 58.6% of patients achieving PASI 100 at week 16 (vs. 20.9% for ustekinumab).
“There’s a great result at week 4 or week 16, but psoriasis is a chronic disease,” Kircik said. “Show me the money, and the money is in the long-term results, what’s happening in a year.”
The results persist at 1 year with “no loss of efficacy,” he said, with patients maintaining PASI 100.
Long-term efficacy helps reduce the administrative burden caused by insurance companies.
Otherwise, “every year, every 6 months, we have to change people from one biologic to another, another prior authorization, another paperwork,” Kircik said. “As we all know, it is difficult to get any biologic approved. ... So, it’s great if you can keep the person for years and years on the same biologic as effective as it was on day 1.”
Kircik anticipates that the barriers introduced by insurance companies will remain long term. “COVID [or] no COVID, unfortunately, the administrative burden, the cost of prior authorization in dermatology, the insurance companies [...] are not going anywhere,” he said.
Furthermore, the adverse event profile of bimekizumab is manageable, according to Kircik. Kircik said the occurrence of Candida is “expected when you suppress the immune system,” but it should not be a deterrent.
“We are in dermatology ... we know how to treat Candida,” Kircik said. Ketoconazole, “the cheapest generic antifungal anti-Candida medication,” and fluconazole, a “widely available safe antifungal,” are both effective, “so I wouldn’t worry about this Candida infection,” he said.