Improving systemic therapy selection for inflammatory skin diseases: A clinical need survey.

Background: Empirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased health care costs. However, routine molecular testing for AD and PSO are lacking.
Objective: To examine (1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and (2) to determine how often the current approach leads to patients switching medications.
Methods: A 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.
Results: Clinicians participating in the survey (265/414, 64% response rate) ranked "reported efficacy" as the most important factor governing treatment choice ( P  < .001). However, 62% (165/265) of clinicians estimated that 2 or more systemic medications were typically required to achieve efficacy. Over 90% (239/265) of respondents would or would likely find a molecular test to guide therapeutic selection useful.
Limitations: To facilitate ease of recall, questions focused on systemic therapies as a whole and not individual therapies.
Conclusion: Clinicians want a molecular test to help determine the most efficacious drug for individual patients.
Competing Interests: Dr Brownstone received a stipend paid for by Castle Biosciences, Inc. Dr Farberg is a consultant for Castle Biosciences, Inc and on the advisory board for Amgen, Boehringer Ingelheim, Eli Lilly, Galderma, Incyte, Janssen, Novartis, Ortho Dermatologics, Pfizer, and Sun Pharma. Drs Quick, Siegel, Hurton, and Goldberg are employees and option and stockholders for Castle Biosciences, Inc. Dr Lio reports research grants/funding from AbbVie, AOBiome, Eczema Foundation, National Eczema Association; is on the speaker's bureau for AbbVie, Eli Lilly, Galderma, Hyphens Pharma, Incyte, La Roche-Posay/L’Oreal, MyOR Diagnostics, ParentMD, Pfizer, Pierre-Fabre Dermatologie, and Regeneron/Sanofi Genzyme; reports consulting/advisory boards for AbbVie, Almirall, Amyris, Arbonne, ASLAN, Bodewell, Boston Skin Science, Bristol-Myers Squibb, Burt’s Bees, Castle Biosciences, Codex Labs, Concerto Biosci, Dermavant, Dermira, DermVeda, Eli Lilly, Galderma, IntraDerm, Janssen, Johnson & Johnson, Kaleido Biosci, Kimberly Clark, LEO Pharma, Lipidor, L’Oreal, Menlo Therapeutics, Merck, Micreos, MyOR Diagnostics, Regeneron/Sanofi Genzyme, Sibel Health, Skinfix, Sonica, Theraplex, UCB, Unilever, Verrica, and Yobee Care; reports stock options with LearnSkin/Learn Health, Medable, Micreos, Modernizing Medicine, and Yobee Care. In addition, Dr Lio has a patent pending for a Theraplex product with royalties paid and is a Board member and Scientific Advisory Committee Member of the National Eczema Association. Author Litchman has no conflicts of interest to declare.
(© 2024 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.)