sample_data/psoriasis_study/Dermatologist_01_Academic_Center.txt

Interview Transcript - Dermatologist #1
Date: October 20, 2025
Interviewee Type: HCP (Dermatologist)
Location: Major Academic Medical Center, Boston
Years in Practice: 18 years
Specialty: Moderate-to-Severe Psoriasis, Biologics
Patient Volume: ~300 psoriasis patients

Interview Content:

Interviewer: Thank you for taking the time to discuss your experience with psoriasis treatments. Can you start by describing your typical psoriasis patient population?

HCP: Sure. At an academic center, we tend to see the more complex cases - patients who've failed multiple therapies, those with extensive body surface area involvement, or patients with comorbidities that complicate treatment. I'd say 70-80% of my psoriasis patients are on biologics. The rest are either new diagnoses where we're trying topicals and phototherapy first, or patients who refuse biologics for various reasons - usually cost or fear of immunosuppression.

Interviewer: When you're considering a biologic like Dermovia for a patient, what factors drive your decision?

HCP: "It's really a constellation of factors. First and foremost is efficacy - can this drug get my patient to PASI 90 or better? Dermovia has been impressive in that regard. In the pivotal trials, we saw 75% of patients achieving PASI 90 at 16 weeks, which puts it in the upper tier with ixekizumab and brodalumab." But efficacy alone isn't enough. I'm also looking at safety profile, dosing convenience, insurance coverage, and increasingly, speed of onset.

Interviewer: You mentioned speed of onset. How important is that clinically?

HCP: Extremely important, especially for patients in crisis. I have patients who come in with 40-50% body surface area involvement, painful plaques on their hands and feet that prevent them from working, scalp lesions that are socially devastating. These patients need relief now, not in 12-16 weeks. "Dermovia has a pretty rapid onset - I'm seeing significant improvement by week 4 in most patients, and some patients report feeling better within the first two weeks." That's comparable to the IL-17 inhibitors and faster than the TNF-alphas.

Interviewer: How does Dermovia compare to other IL-17 inhibitors you've used?

HCP: That's the million-dollar question, right? Dermovia is an IL-17A inhibitor, similar to secukinumab and ixekizumab. In head-to-head data, it seems to be roughly equivalent to ixekizumab in terms of PASI 90 rates, maybe slightly behind on PASI 100. Where I think Dermovia shines is in the dosing schedule. It's every 12 weeks after the loading dose, versus every 4 weeks for secukinumab or every 2-4 weeks for ixekizumab. "For patients who are needle-phobic or just tired of frequent injections, that quarterly dosing is a huge advantage."

Interviewer: What about side effects? What are you seeing in practice?

HCP: The safety profile has been pretty clean in my experience. The most common issue is injection site reactions - redness, itching, mild pain. I'd say maybe 30-35% of my patients report this, but it's usually mild and improves over time. "The more concerning issue is infections. We're suppressing IL-17, which is important for mucosal immunity, so we see an uptick in candida infections - oral thrush, vaginal yeast infections, occasionally esophageal candida." I counsel all my patients about this upfront and give them a prescription for fluconazole to keep on hand.

Interviewer: How often are you seeing serious infections?

HCP: Serious infections are rare, thankfully. In my practice, I've had maybe 2-3 cases of serious infection in patients on Dermovia over the past 18 months - one case of pneumonia requiring hospitalization, one severe cellulitis, and one patient who developed diverticulitis. That's out of probably 60-70 patients I've started on Dermovia, so roughly 4-5%. It's consistent with what we see in the clinical trials and with other IL-17 inhibitors.

Interviewer: What about inflammatory bowel disease? There's been some concern with IL-17 inhibitors potentially exacerbating IBD.

HCP: Yes, that's a real concern. "IL-17 actually has a protective role in the gut, so when you inhibit it systemically, you can unmask or worsen Crohn's disease or ulcerative colitis." I screen all my patients carefully for GI symptoms before starting Dermovia. If they have any history of IBD or chronic diarrhea, I steer them toward a different mechanism - usually a TNF-alpha inhibitor or an IL-23 inhibitor like guselkumab, which doesn't have the same IBD risk. I'd say this eliminates about 10-15% of my potential Dermovia candidates.

Interviewer: Let's talk about insurance and access. What's your experience been?

HCP: "Insurance is the biggest barrier I face. Period." Even though Dermovia is on most formularies now, the prior authorization process is brutal. I have two full-time staff members who do nothing but prior auths and appeals for biologics. For Dermovia specifically, we're seeing approval within 7-10 days for about 60% of patients. The other 40% require additional documentation, letters of medical necessity, peer-to-peer reviews. Some cases take 4-6 weeks to get approved.

Interviewer: What happens during that waiting period?

HCP: That's where it gets really frustrating. We try to bridge patients with topical steroids, maybe a short course of oral steroids if they're really suffering. But these are patients who need systemic therapy, and the delay can lead to worsening disease. I've had patients lose work time, relationships suffer, mental health decline. "One patient told me he stopped going to his daughter's soccer games because he was so self-conscious about his skin. By the time insurance approved Dermovia six weeks later, he'd already missed half her season."

Interviewer: Have you tried patient assistance programs?

HCP: Absolutely. The Dermovia manufacturer has a pretty robust copay card program. For commercially insured patients, it can reduce out-of-pocket costs to $5-25 per month, which is fantastic. The problem is Medicare and Medicaid patients don't qualify for copay assistance, and those are often the patients who can least afford a $3,000-5,000 per month medication. For them, we have to go through the manufacturer's patient assistance foundation, which is another 2-4 week process with income verification, lots of paperwork.

Interviewer: What percentage of your patients ultimately get access to Dermovia if you prescribe it?

HCP: I'd say about 85-90% eventually get on it. The other 10-15% either don't qualify for assistance, can't navigate the paperwork, or give up waiting and we switch to something else. It's heartbreaking because in many cases, Dermovia would be the best option for that patient based on their disease characteristics and prior treatment history.

Interviewer: How long do patients typically stay on Dermovia?

HCP: That's highly variable. For patients who respond well and tolerate it, I have some who've been on it for 2-3 years continuously with maintained response. But there's a subset of patients - maybe 20-25% - who lose response over time. We call it secondary non-response. They do great initially, but after 6-12 months, the plaques start coming back despite continued dosing.

Interviewer: What do you think causes secondary non-response?

HCP: "Most likely it's anti-drug antibodies. The patient's immune system recognizes Dermovia as foreign and develops neutralizing antibodies that block its effect." We can check for these antibodies, but it's not always clinically useful because by the time they're detectable, the patient has already lost response. When that happens, I usually switch to a different mechanism entirely - if they were on an IL-17 inhibitor, I'll try an IL-23 or a JAK inhibitor.

Interviewer: Speaking of JAK inhibitors, how do you view the new oral options like deucravacitinib?

HCP: The oral JAK inhibitors are exciting because they offer an alternative to injections. Some patients just categorically refuse needles, and for them, an oral medication is the only option they'll consider. "Deucravacitinib has shown good efficacy - about 50-60% PASI 90 at 16 weeks, which is respectable though not quite as high as the IL-17 inhibitors." The daily dosing can be a barrier for adherence, and we're still learning about the long-term safety profile. The FDA black box warnings on JAKs for thrombosis, malignancy, and cardiovascular events make me cautious, especially in older patients with risk factors.

Interviewer: For a newly diagnosed moderate-to-severe psoriasis patient, what's your typical treatment algorithm?

HCP: I usually start with phototherapy if the patient has the time and commitment for thrice-weekly visits. It's effective, relatively safe, and helps me gauge their disease severity and treatment responsiveness. If phototherapy fails or isn't feasible, I move to biologics. "For biologic-naive patients under 65 with no major comorbidities, my first choice is often an IL-17 inhibitor like Dermovia or ixekizumab." The efficacy is excellent, and the safety profile at that age is acceptable. For older patients or those with cardiovascular disease, I lean toward IL-23 inhibitors because they have a cleaner safety signal.

Interviewer: Do you ever use methotrexate or cyclosporine anymore?

HCP: Occasionally, but rarely. Methotrexate is cheap and familiar to rheumatologists who manage psoriatic arthritis, but the efficacy for skin disease is mediocre - you're looking at maybe 30-40% achieving PASI 75, and that's not good enough for most of my patients. Plus, the liver toxicity, bone marrow suppression, and teratogenicity are concerns. Cyclosporine I reserve for short-term use only - maybe a 3-4 month course to get someone under control while we're waiting for insurance to approve a biologic. The kidney toxicity and hypertension make it unsuitable for long-term therapy.

Interviewer: What are the biggest unmet needs you see in psoriasis treatment?

HCP: Several things come to mind. First, better predictive biomarkers. Right now, treatment selection is trial and error. I'd love to be able to tell from a blood test or genetic profile which biologic is most likely to work for a given patient. Second, more options for patients who've failed multiple biologics. I have patients who've been through TNF inhibitors, IL-17s, IL-23s, and still have uncontrolled disease. Third, addressing the insurance and access issues. It's insane that we have these incredibly effective medications and patients can't access them because of bureaucratic barriers.

Interviewer: What about combination therapy? Are you using it?

HCP: Not routinely, but I'll combine treatments in select cases. For example, a patient on Dermovia who has 95% clearance but still has stubborn plaques on the elbows - I might add a topical steroid or calcipotriene for those resistant areas. Or a patient with severe scalp involvement might get Dermovia plus a topical solution. "But combining two biologics is generally not recommended due to infection risk, and insurance won't cover it anyway."

Interviewer: How do you monitor patients on Dermovia?

HCP: I see patients at week 4, week 12, and week 24 initially, then every 6 months if they're stable. At each visit, I calculate PASI score, assess for adverse events, and review a symptom checklist - any signs of infection, new GI symptoms, mood changes. I get baseline labs before starting - CBC, CMP, hepatitis panel, tuberculosis screening. Then I recheck CBC and CMP every 6-12 months. If a patient reports unusual symptoms, I'll do more frequent monitoring.

Interviewer: What do you tell patients about duration of therapy?

HCP: That's a great question. "Psoriasis is a chronic disease, and biologics are suppressive, not curative. I tell patients this is likely a long-term commitment - think years, not months." Some patients ask about drug holidays, and there is some data suggesting you can take breaks if you achieve complete clearance, but in my experience, most patients flare within 2-4 months of stopping. So I generally recommend continuous therapy as long as it's working and tolerated.

Interviewer: Any final thoughts on Dermovia or psoriasis management in general?

HCP: Dermovia is a solid addition to our armamentarium. It's not revolutionary - it's another IL-17 inhibitor in a crowded class - but the quarterly dosing is a real differentiator for the right patient. What excites me more broadly is the pipeline. We have TYK2 inhibitors coming, potentially more selective JAK inhibitors, even some topical agents that might be effective enough to avoid systemics in milder cases. "The future of psoriasis treatment is bright, but we need to solve the access problem. Having great drugs that patients can't afford or can't get approved is almost worse than not having them at all."