INFLAMMATORY SKIN DISEASES

Dr Susanne Farwer: The past decade of dermatology has seen the development and launch of novel therapeutic agents with differentiated modes of action, enabling more targeted treatment approaches with a range of effective and well-tolerated therapies. The introduction of these therapies revolutionised dermatology and I have been very privileged to witness first-hand how these drugs have transformed the lives of patients living with chronic inflammatory dermatoses, such as psoriasis or atopic dermatitis.

Despite these scientific advancements, psoriasis remains a challenge to treat, with a substantial proportion of patients not achieving optimal disease control with the current therapeutic options.

My clinical years exposed me to countless patients desperately seeking that ‘magic pill’, with hopes and expectations for a treatment that will relieve them of the disease burden they have been carrying both mentally and physically. It is these experiences which inspire my passion for improving patient outcomes, and I am excited to be working at the forefront of these advancements.

More than 50% of the UK population are affected by skin disease at some point in their lifetime, with over 13 million people (24%) visiting their GP with a skin condition.1 In comparison to other chronic conditions such as diabetes, chronic obstructive pulmonary disease (COPD) or cardiovascular disease, dermatological conditions still rank low on the government and health policy makers’ agenda.

The high disease burden and wide-ranging impact of psoriasis on people’s daily lives is still underestimated. Furthermore, the high prevalence of co-morbidities affecting joints, psychosocial well-being, and the metabolic system, are often not well understood or acknowledged across the various stakeholders in the healthcare system. Reports show that nearly 60% of people with psoriasis say the disease causes problems in their everyday lives.2 What vividly remains in my memory are the many patient struggles I heard during my clinical years.

Patients consistently report a lack of understanding and awareness of the treatment options available to them, and so they fail to understand what they can and should expect from their treatment. This therefore limits their influence in shared decision making about their treatment pathway, in partnership with their dermatologist.

Currently, the system isn’t working well enough for people with psoriasis, so we are dedicated to working with healthcare professionals and the NHS to find new ways to overcome the systemic challenges that stand between people with skin diseases and access to innovative treatments, and holistic, integrated patient care.

Collaboration is fundamental to delivering transformative solutions to those who need it. While those involved in dermatology – patients, clinicians, payors, patient groups, or the scientists working to unlock the treatments of the future – face different challenges, ultimately, we are all working towards the same goal.

This goal is to ensure better lives for those living with skin disease, and faster access to innovative treatments. By working together as partners, we believe we can significantly reduce the time from diagnosis to effective treatment and ultimately, find ways for everyone to feel comfortable in their own skin and live fulfilled lives, free of physical and emotional burden.

We aim to not just listen to stakeholders and gather their insights, but to also involve them in the co-creation of insightdriven solutions. The recent pan-European EPICENSUS Project showcases our collaborative approach to improving outcomes for people living with psoriasis.3 Initiated in December 2020 by UCB, this integrated consensus programme involves key stakeholders (clinicians, payors and patient advocacy groups representatives) from across eight European countries, and focuses on generating engagement, gathering insights and enabling a multidisciplinary conversation. It will critically evaluate the current standard of care with regards to diagnosis, monitoring, access, and patient-reported outcomes in psoriasis, with results due to be published later this year. We hope that EPICENSUS will ultimately deliver a paradigm shift in outcomes for people with psoriasis, reducing the significant burden on the health care system and enhancing the delivery of future psoriasis care.

New technologies such as machine learning have been successful in predicting the trajectory of patients’ health in various fields such as cancer, diabetic complications, and cardiovascular mortality. Recent studies have shown that although ample data exists on the efficacy of biologics in psoriasis, decision making on treatments is still often based on a trial-and-error approach. In a real-world setting, over 50% of patients required dose adjustment during therapy and 20-50% of patients experienced a relapse, resulting in a switch to another medication.4

The application of such modelling algorithm methods for psoriasis treatment could help to predict long-term responses to biologics. Combining patient variables such as demographic data with disease and therapy specifics has shown promising results in this space.

To make the use of these impressive technologies a common practice, further studies and analyses on a larger and more diverse dataset are needed to identify universally applicable criteria.

The introduction of integrated care systems (ICSs) provides an opportunity to acknowledge the impact of skin conditions on wider society and the healthcare system. It is important that these ICSs are gathering these insights and using them to implement decisions that strive towards integrated approaches to care.

It is also important that we are leveraging the range of data and the latest innovations in digital technologies to accelerate the identification of genetic, tissue and serum markers, to better predict treatment response and drug survival. This will help to optimise datadriven decision-making to personalise treatment and ultimately improve patient outcomes.

Above all, we won’t stop searching for the best solutions so that everyone has the opportunity to feel completely comfortable in their own skin, to leave the burden of skin disease behind, and to lead a healthy and happy life free of embarrassment, stigma, and judgement.

References

1. Visit: www.abpi.org.uk/media/4684/der-0080-0517-dermatology_initiative_report_rev16.pdf
2. Visit: www.mg217.com/your-psoriasis/statistics-aboutpsoriasis
3. Visit: www.ucb.com/patients/magazine/detail/article/Our-Commitment-to-Changing-the-Status-Quo-in-Psoriasis-Care
4. Emam S et al, Predicting the long-term outcomes of biologics in patients with psoriasis using machine learning, Br J Dermatol 182(5): pp1,305-1,307, 2019