“Where Would You Rather Be Than Right Here Right Now?”

Last year, as I was starting my first year as the president of the Dermatology Nurses’ Association, I wrote an article in the April/May 2023 issue about how supportive and encouraging my supervising physician, Dr Robert Kalb, had been to the nurses in our office regarding furthering our education. To begin my second term and at our 42nd Annual Convention in San Diego, CA, this year, we had the honor of having Robert Kalb, MD, as our keynote speaker. He opened his presentation with a quote from Hall of Fame football coach Marv Levy to set the stage for a walk through the biologic landscape of psoriasis therapies: “Where would you rather be than right here right now?” This is an exciting time to be a dermatology provider as recent major advances in targeted therapies based on pathophysiology are in the forefront of treatment strategies and have transformed the treatment toolbox.

Dr Kalb, who is an expert in psoriasis therapies, guided us through the biologic terrain that has blossomed from 1990 with the initial systemic therapy of methotrexate, UVB, PUVA, and inpatient Goeckerman therapy to the abundance of treatment modalities available today. There are currently 12 biologic agents (etanercept, adalimumab, infliximab, certolizumab pegol, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, risankizumab, and bimekizumab), 2 new oral systemic therapies (apremilast and deucravacitinib), as well as 9 adalimumab biosimilars that are available. He explored the conundrum of which therapies should be prescribed—topical, oral systemic, phototherapy, or biologic therapy—and if biologic, which should be first line? There are also barriers put up by insurance companies, such as step therapies and copay costs.

His speech was tailored to our members who not only prescribe but also for those of us who assess treatment outcomes and work to provide access to the most effective therapies. The speech's objectives were to become familiar with the biologic basics and, with that in mind, to advocate vigorously for the patient who frequently needs help navigating a complicated system to obtain the medications. These agents are a major advance in the treatment of psoriasis, but we still face the questions of what should be the first-line therapy, what is the long-term safety profile, and what are the long-term costs? We are still and always learning.

Nancy Smail is the president of the Dermatology Nurses’ Association.