Interview Transcript - Dermatologist #2
Date: October 20, 2025
Interviewee Type: HCP (Dermatologist)
Location: Private Practice, Atlanta, GA
Years in Practice: 12 years
Specialty: General Dermatology with Psoriasis Focus
Patient Volume: ~150 psoriasis patients

Interview Content:

Interviewer: Thanks for meeting with us today. Can you describe your practice and psoriasis patient population?

HCP: I'm in a busy private practice with three other dermatologists. We see about 80-100 patients a day across the practice, and maybe 20-25% have psoriasis to some degree. My personal focus is on moderate-to-severe cases - I have about 150 patients on my panel with psoriasis requiring systemic therapy.

Interviewer: What's been your experience with Dermovia since it launched?

HCP: "I've been really pleased with it. I started using Dermovia about 14 months ago, and I now have approximately 35-40 patients on it." The efficacy has been excellent - I'm seeing PASI 90 responses in probably 70-75% of patients, which matches the trial data. What really sold me on it was the dosing schedule. Every 12 weeks is a game-changer for patient compliance.

Interviewer: Can you elaborate on the compliance issue?

HCP: Sure. In private practice, we see all types of patients - working professionals, parents juggling kids' schedules, elderly patients who need help with injections. "Asking someone to inject themselves every two weeks is a big ask. I've had patients on ixekizumab or secukinumab who forget doses, go on vacation and don't bring their medication, or just get injection fatigue and stop." With Dermovia's quarterly dosing, it's much more manageable. Patients can actually come into the office and have my nurse administer it if they don't want to self-inject.

Interviewer: Do many patients choose in-office administration?

HCP: About 30-40% of my Dermovia patients come in for their injections. Some are needle-phobic and just can't bring themselves to self-inject. Others, particularly elderly patients, worry about doing it wrong or don't have the dexterity. We schedule them every 12 weeks, it takes 5 minutes, and they're good to go. Insurance covers it as a physician-administered drug, so there's no financial barrier.

Interviewer: How do you decide when to use Dermovia versus other biologics?

HCP: I have my go-to algorithms, but honestly, insurance formulary plays a huge role. I'll look at what's on the patient's preferred tier, because a non-preferred drug might require step therapy or have a much higher copay. If Dermovia is covered equally with other IL-17 inhibitors, I'll choose it for patients who value convenience or have had compliance issues with prior therapies. "For someone who travels frequently for work, quarterly dosing means they're not dealing with refrigerated medications in hotels or worrying about TSA with syringes."

Interviewer: What about efficacy differences between the IL-17 inhibitors?

HCP: In the real world, I honestly don't see huge differences. The trials show some numerical differences - brodalumab might edge out ixekizumab by a few percentage points on PASI 100, ixekizumab might beat secukinumab - but when you're dealing with individual patients, those differences often disappear. I've had patients who failed secukinumab but responded beautifully to Dermovia, and vice versa. "Patient-to-patient variability is huge, and we don't have great tools to predict who'll respond to what."

Interviewer: Let's talk about side effects. What are you seeing?

HCP: The usual suspects with IL-17 inhibition. Candida infections are number one - I'd say 25-30% of my patients will have at least one episode of oral thrush or vaginal candidiasis in the first year. It's usually easily treated with topical or oral antifungals. Upper respiratory infections are also common, maybe 40-50% report more colds or sinus infections than usual. Most patients accept this as a reasonable trade-off for clear skin.

Interviewer: Have you had any serious adverse events?

HCP: I've had two cases that gave me pause. One patient developed pretty severe depression about six months after starting Dermovia. She had a history of mild anxiety but nothing like this - she became suicidal and needed hospitalization. We stopped the Dermovia, started her on antidepressants, and she improved over the next few months. I can't prove it was the drug, but the temporal relationship was concerning. "The other case was a 58-year-old man who developed atrial fibrillation about four months into treatment. Again, hard to say if it was causal, but I discontinued the medication out of abundance of caution."

Interviewer: Those cases didn't appear in the clinical trials, did they?

HCP: No, and that's the thing with post-marketing surveillance. The trials had maybe 1,500-2,000 patients total, followed for 1-2 years. Once you're treating tens of thousands of patients in the real world, you're going to see rare events that didn't show up in trials. I reported both cases to the FDA's MedWatch system. I'm not saying Dermovia caused them, but we need to be vigilant.

Interviewer: How do you counsel patients about the risks of biologics?

HCP: I try to be balanced. I tell them, "This medication is going to dramatically improve your skin - we're talking 80-90% clearance for most patients. But it works by suppressing part of your immune system, so there are risks." I go through the infection risk, the small theoretical risk of malignancy, the possibility of injection reactions. "For most patients, the benefit-to-risk ratio is clearly favorable. You're talking about someone whose psoriasis is ruining their quality of life versus a modest increase in common infections."

Interviewer: What about cost? How do your patients handle it?

HCP: Cost is a huge issue. The list price for Dermovia is about $82,000 per year. With the copay card, commercially insured patients usually pay $10-50 per dose, so $40-200 per year, which is manageable. "The problem is the uninsured and underinsured. I have patients with high-deductible plans who face $5,000-10,000 in out-of-pocket costs before the copay card kicks in." Some patients max out their credit cards or take out loans to pay for it. It's heartbreaking.

Interviewer: Have you had patients who couldn't afford to start or continue Dermovia?

HCP: Yes, unfortunately. I've had probably 5-6 patients in the past year who got approved for Dermovia but couldn't afford the copay even with assistance. There's also the issue of insurance churn - someone starts Dermovia, does great for 6 months, then changes jobs and their new insurance doesn't cover it. They have to start the whole prior auth process over, maybe switch to a different biologic. "It's incredibly disruptive to care, and it's frustrating for both me and the patient."

Interviewer: How long does the prior authorization process typically take for Dermovia?

HCP: In my experience, average is about 10-14 days if everything goes smoothly. But maybe 30-40% of cases require a peer-to-peer review or additional documentation, and then you're looking at 3-4 weeks minimum. I've had cases drag on for two months with multiple denials and appeals. During that time, the patient is suffering.

Interviewer: Do you use bridge therapy while waiting for approval?

HCP: Yes, I'll typically use topical steroids, maybe vitamin D analogs. For patients who are really severe, I might do a short course of oral prednisone - 20-30mg daily for a week or two to get them some relief. But I'm always worried about rebound flares when you stop the prednisone, so I try to avoid it if possible.

Interviewer: How do you monitor treatment response?

HCP: I bring patients back at 4 weeks, 12 weeks, and 24 weeks for the first six months. At each visit, I do a full skin exam, calculate PASI, and use a lot of photography to track progress. Patients love seeing the before-and-after photos - it's really motivating for them. After six months, if they're stable, I extend to 6-month follow-ups. But I tell patients to call immediately if they develop any concerning symptoms - fever, severe infection, GI symptoms, anything unusual.

Interviewer: What percentage of your Dermovia patients achieve PASI 90?

HCP: In my practice, I'd say about 70-75% achieve PASI 90 by week 16. Another 10-15% get to PASI 75 but not 90 - they're significantly better but not quite there. The remaining 10-15% are either non-responders or partial responders that I end up switching to something else.

Interviewer: What do you do with the non-responders?

HCP: If someone hasn't achieved at least PASI 50 by week 16, I consider them a primary non-responder and switch mechanisms. "If they were on an IL-17 inhibitor like Dermovia, I'll try an IL-23 inhibitor like risankizumab or guselkumab." The IL-23s have a slightly different efficacy profile and sometimes work in patients who failed IL-17s. If they fail multiple biologics, that's when I consider JAK inhibitors or even combination therapy.

Interviewer: Have you seen patients lose response over time?

HCP: Yes, secondary loss of response is a real phenomenon. I'd estimate 15-20% of patients who initially respond will lose that response over 12-24 months. Their plaques start coming back, PASI scores creep up. When that happens, I'll usually check for anti-drug antibodies and consider switching to a different agent. "Occasionally, I'll try dose intensification - like going from every 12 weeks to every 8 weeks - but insurance rarely approves that without a fight."

Interviewer: How does Dermovia compare on speed of onset versus other biologics?

HCP: It's pretty fast. I tell patients they should see noticeable improvement by week 4, significant improvement by week 8, and maximal response by week 12-16. That's similar to other IL-17 inhibitors and faster than the IL-23s, which can take 12-16 weeks for maximal effect. "Speed matters because patients are impatient - understandably so. If they're not seeing improvement by week 4-6, they start questioning whether it's working."

Interviewer: Do you treat psoriatic arthritis patients with Dermovia?

HCP: I do have some patients with both psoriasis and psoriatic arthritis who are on Dermovia. It's FDA-approved for both indications. The skin clearance is excellent, and most patients report improvement in joint symptoms too. "But for patients with predominantly joint disease and minimal skin involvement, I usually defer to rheumatology. They're more comfortable managing PsA and might choose a TNF inhibitor or JAK inhibitor that has stronger musculoskeletal data."

Interviewer: What about special populations - pregnant women, pediatric patients?

HCP: Dermovia is Category C in pregnancy, which means we don't have good safety data. I counsel women of childbearing age to use effective contraception while on Dermovia. If a patient is actively trying to conceive, I usually recommend stopping the biologic or switching to something with more pregnancy data, like certolizumab. For pediatric patients, Dermovia is approved down to age 6, but I don't see many kids in my practice. The few I have treated have done well, though getting parents comfortable with injecting their child is a challenge.

Interviewer: What's your success rate in getting patients to PASI 100 - complete clearance?

HCP: PASI 100 is the holy grail, and Dermovia gets us there in maybe 30-40% of patients. That's respectable but not as high as the 50-60% seen with brodalumab or ixekizumab in trials. In real-world practice, I find those numbers are a bit optimistic anyway. Complete clearance is harder to achieve than the trials suggest, especially in patients with chronic, long-standing disease or who've failed prior therapies.

Interviewer: How important is complete clearance versus PASI 90?

HCP: That depends on the patient. Some patients are thrilled with 90% improvement - they can wear short sleeves again, go swimming, feel normal. Others are perfectionists and won't be satisfied until every last plaque is gone. "I try to set realistic expectations. PASI 90 is an excellent result and represents life-changing improvement for most patients. If we can get to PASI 100, that's fantastic, but it shouldn't be the only marker of success."

Interviewer: Any challenges unique to private practice versus academic centers?

HCP: The biggest difference is resources. Academic centers have research coordinators, prior auth specialists, dedicated biologic infusion centers. In private practice, it's me and my medical assistant handling everything. We're much more cost-conscious too - every prior auth that gets denied means hours of staff time, phone calls, appeals. "We've gotten very good at navigating the insurance maze, but it's exhausting and takes time away from patient care."

Interviewer: Would you recommend Dermovia to a colleague?

HCP: Absolutely. It's a solid, effective medication with a convenient dosing schedule and a manageable side effect profile. Is it better than ixekizumab or risankizumab? Not dramatically, but the quarterly dosing is a real advantage for the right patient. "In a crowded marketplace, that convenience factor can be the tiebreaker." I'd say it deserves a place in every dermatologist's toolkit.

Interviewer: Any final thoughts?

HCP: Just that psoriasis treatment has come so far in the past 15 years. When I started practice, we were using methotrexate and light therapy and hoping for 50-60% improvement. Now, with biologics like Dermovia, we're routinely achieving 80-90% clearance or better. The future is even brighter with new mechanisms in development. "The challenge now isn't efficacy - it's access. We need to solve the insurance and cost barriers so every patient who needs a biologic can get one."