sample_data/psoriasis_study/Dermatologist_05_Teaching_Hospital.txt

Interview Transcript - Dermatologist #5
Date: October 20, 2025
Interviewee Type: HCP (Dermatologist)
Location: Teaching Hospital, Chicago, IL
Years in Practice: 6 years
Specialty: Psoriasis and Psoriatic Arthritis
Patient Volume: ~180 psoriasis patients

Interview Content:

Interviewer: Thank you for meeting with us. Can you describe your role at the teaching hospital?

HCP: I'm an assistant professor of dermatology, and I run the psoriasis clinic at our teaching hospital. I see patients myself, but I also supervise residents and fellows. About 60% of my time is clinical, 20% is teaching, and 20% is research. My patient population is a mix of routine psoriasis cases that residents can learn from and complex cases that get referred from community dermatologists.

Interviewer: How long have you been using Dermovia?

HCP: I've been prescribing Dermovia for about 11 months. I was actually involved in the Phase 3 clinical trial as a sub-investigator, so I got to see the drug's performance before it launched. "I was impressed by the efficacy data - 75% PASI 90 at 16 weeks put it right up there with ixekizumab and brodalumab." Once it launched, I started prescribing it for appropriate patients.

Interviewer: How many patients do you currently have on Dermovia?

HCP: I'd say about 30-35 patients. That's out of my total panel of 180 psoriasis patients. The rest are on a mix of other biologics - IL-17s, IL-23s, TNF inhibitors - or oral agents like apremilast or deucravacitinib. A few are on clinical trial medications that I can't discuss.

Interviewer: What patient profile is ideal for Dermovia?

HCP: Great question. "I think Dermovia is ideal for patients who have moderate-to-severe plaque psoriasis, have failed or don't tolerate topicals and phototherapy, and value dosing convenience. The quarterly dosing is a major differentiator." I also consider it for patients who've had compliance issues with more frequent biologics. If someone was on ixekizumab and kept missing doses, switching to quarterly dosing can solve that problem.

Interviewer: Are there patients you wouldn't use Dermovia for?

HCP: Yes. I avoid IL-17 inhibitors in patients with inflammatory bowel disease or a strong family history of Crohn's or UC. IL-17 has a protective role in the gut, so inhibiting it can unmask or worsen IBD. "I screen every patient for GI symptoms before starting any IL-17 inhibitor. If they have chronic diarrhea, abdominal pain, rectal bleeding - anything concerning - I steer them toward an IL-23 inhibitor or a TNF-alpha inhibitor instead." That probably excludes 10-15% of potential candidates.

Interviewer: What about efficacy? What are you seeing in real-world practice?

HCP: The real-world efficacy is very close to the trial data, which is always reassuring. I'm seeing PASI 90 in about 70-75% of patients by week 16. PASI 100 - complete clearance - in about 35-40%. "Those numbers are excellent and consistent with what we saw in the Phase 3 trial." The onset is rapid, too. Most patients see noticeable improvement by week 4, significant clearance by week 8.

Interviewer: How does that compare to other IL-17 inhibitors?

HCP: Head-to-head, I'd say Dermovia is roughly equivalent to ixekizumab. Maybe a few percentage points behind ixekizumab on PASI 100 rates, but we're splitting hairs at that point. Secukinumab is slightly less effective - maybe 60-65% PASI 90 - but it's been around longer and has more long-term safety data. Brodalumab is the most effective IL-17 inhibitor, but the black box warning for suicidality makes prescribing it complicated.

Interviewer: Tell me about the brodalumab black box warning. Does that affect your prescribing?

HCP: Absolutely. Brodalumab has a black box warning because a handful of patients in the clinical trials died by suicide. The causal relationship is unclear - psoriasis itself is associated with depression and suicidality - but the FDA required the warning. "To prescribe brodalumab, patients have to enroll in a REMS program, which adds administrative burden. So even though brodalumab might be slightly more effective, I often choose Dermovia or ixekizumab instead to avoid the hassle."

Interviewer: What about safety with Dermovia specifically?

HCP: The safety profile has been very manageable. The most common issue is candida infections - oral thrush, vaginal yeast infections, occasionally esophageal candidiasis. "I counsel all my patients about this upfront and tell them to call immediately if they develop white patches in their mouth or painful swallowing." We treat with fluconazole, and most cases resolve quickly. I've had one patient with recurrent candida who we eventually switched to an IL-23 inhibitor.

Interviewer: What about serious infections?

HCP: I've had two cases of serious infection in my Dermovia patients. One was pneumonia requiring hospitalization - a 67-year-old man with diabetes and COPD, so multiple risk factors. The other was a severe case of herpes zoster that spread across multiple dermatomes. We stopped Dermovia temporarily in both cases, treated the infections, and then made individualized decisions about whether to restart. "The pneumonia patient we switched to an IL-23 inhibitor because of his comorbidities. The zoster patient we restarted on Dermovia after vaccination with Shingrix, and he's done fine."

Interviewer: Do you vaccinate patients before starting biologics?

HCP: Yes, that's part of my standard protocol. Before starting any biologic, I check vaccination status and update as needed. Tdap, flu vaccine, COVID vaccine, Shingrix for anyone over 50. We also screen for latent TB and hepatitis B. "You want to make sure patients are as protected as possible before you start immunosuppression." That said, we use live vaccines with caution - you want to give those at least 2-4 weeks before starting the biologic.

Interviewer: Let's talk about the dosing schedule. How important is the quarterly dosing?

HCP: It's a significant advantage, especially for certain patient populations. Young professionals who travel for work love it. Parents with busy schedules appreciate it. "I have one patient who's a consultant and flies 200 days a year. He was on secukinumab and constantly worrying about refrigeration in hotel minibars. Switching to Dermovia meant he could come to the clinic every 12 weeks, get his injection, and forget about it."

Interviewer: Do patients do self-injection or come to the clinic?

HCP: It's about 50-50. Half prefer self-injection at home - they like the autonomy and not having to come to the clinic. The other half prefer in-office administration - they're anxious about doing it themselves or they just like the reassurance of having a nurse do it. "We're flexible and let patients choose. The quarterly schedule makes in-office administration much more feasible than with every-two-week dosing."

Interviewer: How do you teach self-injection to patients?

HCP: Our nursing staff does a training session at the first visit. They use a demo pen, walk through the steps, watch the patient do a practice injection with saline, then supervise the first real injection. Most patients get comfortable pretty quickly. The Dermovia pen is well-designed - it's a single-use autoinjector with a hidden needle, so patients don't see the needle, which reduces anxiety. "We also give them the manufacturer's video tutorials and a 24-hour nurse hotline they can call with questions."

Interviewer: What about insurance coverage? How's the prior authorization process?

HCP: At a teaching hospital, we have a dedicated prior auth team, which is a huge advantage. Even so, getting biologics approved is time-consuming. For Dermovia, I'd estimate 50-60% get approved within 7-10 days. The other 40-50% require additional documentation, letters of medical necessity, sometimes peer-to-peer calls. "The insurance companies have these algorithms - you have to fail topicals, then phototherapy, then maybe methotrexate before they'll approve a biologic. Even if the patient comes to me with severe psoriasis that clearly needs systemic therapy, I have to jump through those hoops."

Interviewer: How do you handle step therapy requirements?

HCP: I try to document prior failures thoroughly. If a patient comes to me already having tried topical steroids, phototherapy, and methotrexate, I document all of that in the prior auth. If the patient is biologic-naive, sometimes I'll start with a cheaper biologic like adalimumab, which has biosimilars, and then switch to Dermovia if they fail or don't tolerate it. "It's frustrating because I know what's going to work best based on the data, but insurance wants me to try cheaper options first."

Interviewer: What's the typical out-of-pocket cost for your patients?

HCP: For commercially insured patients, the manufacturer's copay card usually brings it down to $5-25 per dose. For four doses a year, that's $20-100 annually, which is very manageable. Medicare patients are more challenging because they can't use copay cards. Their out-of-pocket can be $2,000-5,000 per year depending on their plan. "We have a financial counselor who helps those patients apply for manufacturer patient assistance programs or charitable foundation grants. Probably 80-85% eventually get help, but it takes time and effort."

Interviewer: Have you had patients unable to start or continue Dermovia due to cost?

HCP: Yes, unfortunately. I'd say about 10% of patients I prescribe Dermovia for end up not starting it or discontinuing it due to cost. Usually these are Medicare patients or patients with high-deductible plans. "One patient was quoted $8,000 for her first year out-of-pocket. She was a retired teacher on a fixed income - there was no way she could afford it. We ended up switching her to apremilast, which was more affordable but less effective."

Interviewer: Let's discuss long-term outcomes. How long do patients stay on Dermovia?

HCP: My longest patient has been on it for 11 months - the same duration I've been prescribing it. So far, retention has been excellent. I've only had three patients discontinue: one due to recurrent candida, one who moved and changed insurance, and one who developed possible IBD symptoms and we stopped it out of caution. "The other 85-90% are still on it and doing well. No secondary loss of response yet, though I know that's a risk over time."

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

HCP: I explain that psoriasis is a chronic disease and biologics are suppressive, not curative. "I say, 'This medication will control your psoriasis as long as you're taking it, but if you stop, there's a high chance it will come back.' Most patients understand that and are comfortable with long-term therapy." Some ask about drug holidays, and I explain that while it's theoretically possible if you achieve complete clearance, most patients flare within weeks to months of stopping.

Interviewer: Have you seen any patients develop anti-drug antibodies?

HCP: Not yet with Dermovia, but it's too early to tell. Anti-drug antibodies typically develop after 6-24 months of therapy. They can neutralize the medication and lead to secondary loss of response. "If I suspect anti-drug antibodies - patient was responding well but now their psoriasis is coming back despite continued dosing - I'll check trough drug levels and antibody titers. If antibodies are present, I switch to a different mechanism."

Interviewer: How do you approach switching biologics?

HCP: If a patient fails an IL-17 inhibitor like Dermovia, I usually switch to a different mechanism - either an IL-23 inhibitor or a JAK inhibitor. The IL-23s like risankizumab and guselkumab have excellent efficacy and might work in patients who didn't respond to IL-17 inhibition. "The JAK inhibitors are interesting because they're oral, which some patients prefer, but the FDA black box warnings for thrombosis, malignancy, and cardiovascular events make me cautious."

Interviewer: Tell me more about the JAK inhibitor warnings. How does that affect your prescribing?

HCP: The FDA issued black box warnings for JAK inhibitors based on data from rheumatoid arthritis trials showing increased risks of blood clots, heart attacks, strokes, and cancer, especially in patients over 50 with cardiovascular risk factors. "For psoriasis, the approved JAK inhibitor deucravacitinib is more selective and might have a different risk profile, but we don't have long-term data yet." I'm cautious about using it in older patients or anyone with a history of cardiovascular disease. For those patients, I stick with biologics like Dermovia.

Interviewer: How does Dermovia compare to IL-23 inhibitors?

HCP: The IL-23 inhibitors - risankizumab, guselkumab, tildrakizumab - have slightly different efficacy profiles. Risankizumab is probably the most effective, achieving PASI 90 in 75-80% of patients, which is comparable to Dermovia. "Where IL-23 inhibitors shine is safety. They don't seem to increase candida infections the way IL-17 inhibitors do, and they don't have the IBD risk." The trade-off is slower onset - IL-23s can take 12-16 weeks for maximal effect, whereas Dermovia shows results by week 4-6.

Interviewer: How important is speed of onset clinically?

HCP: Very important, especially for patients in crisis. I have patients who come in with 50-60% body surface area involvement, severe itch, pain, emotional distress. They need relief now. "If I start them on an IL-23 inhibitor and tell them it'll take 12-16 weeks to see full results, they're demoralized. With Dermovia, I can tell them, 'You'll start seeing improvement in 4-6 weeks,' and that gives them hope." So for patients who need rapid results, I lean toward IL-17 inhibitors.

Interviewer: Do you combine treatments?

HCP: Yes, sometimes. I might combine a biologic like Dermovia with topical steroids for localized stubborn plaques. Or combine with phototherapy if the patient has widespread involvement that's not quite clearing completely. "But I don't combine two biologics - the infection risk is too high, and insurance won't cover it anyway." The goal is to use the minimum effective therapy.

Interviewer: What about special populations? Pregnant women, pediatric patients?

HCP: Dermovia is pregnancy category C, meaning we don't have good human data. I counsel women of childbearing age to use effective contraception while on Dermovia. If a patient is planning to conceive, I usually switch to certolizumab pegol, which is the only biologic with substantial pregnancy safety data. "For pediatric patients, Dermovia is approved down to age 6. I've treated a few adolescents with excellent results. Getting parental buy-in for biologic therapy can be challenging, but when the psoriasis is severe enough, parents are usually willing to try."

Interviewer: How do you measure treatment success?

HCP: My primary outcome is PASI 90 by week 16. That's the gold standard in clinical trials and what I aim for in practice. I also use patient-reported outcomes - DLQI (Dermatology Life Quality Index) and patient satisfaction surveys. "A patient might achieve PASI 90, but if they still feel their quality of life is impaired, that's important to know." I photograph all my patients at baseline and follow-up visits for documentation and to show them their progress.

Interviewer: What role do residents and fellows play in psoriasis management?

HCP: They're integral to our practice. Residents see patients with me in clinic and learn to calculate PASI scores, interpret lab results, counsel patients about biologics. Fellows get more autonomy and might manage patients independently with my supervision. "It's important for trainees to learn biologic management because this is where dermatology is headed. Twenty years ago, psoriasis treatment was mostly topicals and light therapy. Now it's biologic-heavy, and the next generation needs to be comfortable with that."

Interviewer: What do you teach residents about choosing biologics?

HCP: I teach them to consider multiple factors: efficacy, safety, dosing convenience, insurance coverage, patient preferences. "There's no one 'best' biologic. The best biologic is the one that works for that specific patient, that they can afford, that they'll actually use." I also teach them to be pragmatic about insurance - you can prescribe the newest, most expensive drug, but if the patient can't get it approved or afford it, you've done them no favors.

Interviewer: Any research you're conducting on Dermovia?

HCP: We're not conducting Dermovia-specific research currently, but we're involved in several psoriasis trials for novel therapies. We're also doing observational research on real-world biologic effectiveness and patient-reported outcomes. "One thing I'm interested in is predictive biomarkers - can we identify genetic or protein markers that predict which patients will respond to which biologics? Right now it's trial and error, but in the future, we might be able to personalize treatment from day one."

Interviewer: Would you recommend Dermovia to a colleague?

HCP: Yes, absolutely. It's a solid, effective medication with a convenient dosing schedule and a manageable safety profile. Is it revolutionary? No. It's another IL-17 inhibitor in a competitive class. "But the quarterly dosing is a meaningful differentiator, and for the right patient, it can be the best choice." I'd recommend colleagues become familiar with it and consider it in their treatment algorithms.

Interviewer: Any final thoughts?

HCP: Just that we're in a golden age of psoriasis treatment. We have more effective, safer options than ever before. But we need to address the access barriers - the prior auth red tape, the high costs, the insurance denials. "Every patient with moderate-to-severe psoriasis should have access to an effective biologic. The fact that we have to fight so hard to get these medications approved is a systemic failure." But I'll keep fighting for my patients because they deserve it.

Interviewer: Thank you for your time and insights.

HCP: My pleasure. I hope this is helpful for your research.