TNF inhibitors vs. IL-17/IL-23 inhibitors for psoriasis and PsA
With the availability of IL-17 (secukinumab, ixekizumab, brodalumab) and IL-23 inhibitors (guselkumab, tildrakizumab, risankizumab), dermatologists and rheumatologists are asking whether it’s time to reconsider the use of TNF inhibitors (etanercept, infliximab, adalimumab) as first-line therapy in psoriasis and psoriatic arthritis (PsA), according to an MDedge report on the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2021 annual meeting.
At the virtual meeting, dermatologists and rheumatologists cited studies showing safety and efficacy of both IL-17 and IL-23 inhibitors over TNF inhibitors, with some studies showing that non–TNF-inhibitor biologics have a higher efficacy than TNF inhibitors in some cases, such as those with moderate to severe psoriasis alone or for musculoskeletal efficacy in patients with PsA who have peripheral arthritis, enthesitis, dactylitis, or axial manifestations. Also, IL-17 and IL-23 inhibitors tend to have less frequent maintenance dosing and fewer safety concerns than TNF inhibitors.
Others, however, argued in favor of TNF inhibitors as first-line therapy over IL-17 and IL-23 inhibitors because of cost and accessibility — access to TNF inhibitors is widespread, costs are generally lower, and there is more long-term safety data.
Experts break down emerging psoriasis treatment options and what they can offer patients and physicians in this month’s DermWorld.
DermWorld Insights and Inquiries: Immediate pathology report release to patients — Is the 21st Century CURES Act worse than the disease?
The 21st Century Cures Act, signed into federal law in 2016, was enacted to optimize medical product development and advance patient access to medical innovations. Notable for inclusion of patient perspectives in its provisions, the Act was then given to the Office of the National Coordinator for Health Information Technology (ONC), which was tasked with easing the regulatory burden of utilizing and accessing the electronic health record (EHR). The ONC Final Rule was released in 2020 with a grace period for implementation ending April 2021, requiring that providers and health systems prevent ‘information blocking,’ meaning that patients must have free portable electronic access to their entire health record.
As dermatologists, the most germane portion of this mandate includes sharing pathology results with patients in the EHR as soon as they are available. There are several exceptions to the rule, including Preventing Harm, determined by the ordering provider but strictly outlined as severe physical harm with no sanctioned loophole to summarily delay result release for all patients so that the provider may first interpret the data before the patient receives it. Thus far, the Office of the Inspector General has not delineated the provider penalties for noncompliance with the rules. Keep reading!
Itch in skin of color
In a research letter published in the British Journal of Dermatology, the authors conducted a multicenter, cross-sectional study that included nearly 600,000 patients with chronic pruritic dermatoses.
Compared with white and non-Hispanic individuals, patients with skin of color were more commonly affected by atopic dermatitis, cutaneous T-cell lymphoma, lichen planus, prurigo nodularis, and pruritus. Black patients were more likely to have atopic dermatitis, prurigo nodularis, CTCL, and lichen planus, while Asian patients were over-represented in atopic dermatitis, prurigo nodularis, lichen planus, and pruritus. Hispanics and Native Americans were more likely to have pruritus with Native Americans also being over-represented in lichen planus. White patients were more commonly diagnosed with psoriasis, chronic urticaria, and Grover’s disease. There was no racial difference for bullous pemphigoid.
What does the research say about the use of cannabinoids for the treatment of itch? Find out inDermWorld.
In a prospective cohort study published inJAAD, 30 health care workers were assigned to wear fabric, disposable surgical, or N95 masks for six hours. High-resolution 3D imaging was performed on seven facial regions before and after mask-wearing to quantify changes in erythema index, acne index, and rhytide area or depth.
Erythema index increased across the overall face with all masks. The acne index and rhytide index increased across the overall face with fabric masks. Participants reported increases in erythema and oiliness (all masks), irritation (N95 and surgical masks), and pruritus (N95 masks). There were no significant differences between mask groups for subjective or objective data.
Read a commentary by Christen Mowad, MD, FAAD, about unmasking the complications of personal protective equipment inDermWorld Insights and Inquiries.
2020 MIPS performance feedback, final score, and 2022 payment adjustment
The Centers for Medicare & Medicaid Services (CMS) will be updating the Merit-based Incentive Payment System (MIPS) performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022. More details are coming about what will change from the initial release, who is impacted, and how this will affect MIPS payment adjustments, as well as the new targeted review period deadline.
In the meantime, you can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website. Please note the information available now may be changing. If you have any questions, contact the Quality Payment Program at 1-866-288-8292 or by email at QPP@cms.hhs.gov.
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