Photo Credit: SurfUpVector
On Tuesday, January 21, 2025, Joel Gelfand, MD, will join a panel of speakers to discuss the changing landscape of psoriasis and psoriatic arthritis.
“Their discussion will include new topical and systemic drugs new findings, management strategy updates, psoriatic arthritis, and the immunology and genetics of psoriasis,” explains Maui Derm. “In the final part of the session, a series of challenging case scenarios will be presented. Attendees will then be asked during case studies to weigh in on their selection of therapies on a survey app. Our faculty will then discuss the rationale for their therapeutic selection.”
The session will occur in the Haleakala Ballroom from 11:15 AM – 12:45 PM.
Over the last year, Dr. Glefand has participated in multiple psoriasis-related trials.
Psoriasis Guidelines
According to one panel that he participated in, evidence-based recommendations are needed for psoriatic patients receiving systemic therapies who require vaccination. A consensus developed by the National Psoriasis Foundation Medical Board, COVID-19 Task Force, and infectious disease experts evaluated vaccine efficacy and safety for this population. The recommendations suggest that most oral and biologic therapies can continue without modification for nonlive vaccines, though methotrexate interruption may be considered. For live vaccines, temporary discontinuation of most systemic therapies is advised, including pausing biologics for 2-3 half-lives before and deferring the next dose 2-4 weeks post-vaccination. While these guidelines provide clarity, data on infection rates following vaccination remain limited.
Cardiology and Psoriasis
One study said systemic inflammation and insulin resistance are key drivers of atherosclerosis but are challenging to assess in clinical practice. The monocyte-to-high-density lipoprotein ratio (MHR) serves as an accessible biomarker integrating inflammatory and metabolic data, showing associations with poor cardiovascular outcomes. The study of 405 psoriasis patients from European and American cohorts found that MHR correlates with insulin resistance, high-sensitivity CRP, and inflammatory activity in various tissues. MHR was linked to significant coronary artery plaques and noncalcified coronary burden, independent of traditional cardiovascular risk factors. In the American cohort, MHR enhanced the predictive model for noncalcified coronary burden, suggesting its utility in identifying psoriasis patients with subclinical cardiovascular disease who may benefit from more aggressive preventive strategies.
Similarly, another study Dr. Gelfand participated in observed the use of Janus kinase (JAK) inhibitors. JAK inhibitors are effective treatments for dermatologic conditions but carry an FDA boxed warning for risks like major adverse cardiovascular events (MACE), venous thromboembolism (VTE), serious infections, malignancy, and death, based on rheumatoid arthritis studies. This systematic review and meta-analysis of 35 randomized clinical trials with 20,651 patients evaluated the risks of all-cause mortality, MACE, and VTE in dermatologic settings. The findings showed no significant difference in these risks between JAK inhibitors and placebo/active comparators (eg, OR for MACE and all-cause mortality: 0.83; OR for VTE: 0.52). While these results suggest JAK inhibitors are not associated with increased safety risks in dermatologic use, further long-term studies are needed for comprehensive risk assessment.
