Interview Transcript - Dermatologist #3
Date: October 20, 2025
Interviewee Type: HCP (Dermatologist)
Location: Community Hospital, Phoenix, AZ
Years in Practice: 25 years
Specialty: General Dermatology, Psoriasis
Patient Volume: ~200 psoriasis patients

Interview Content:

Interviewer: Thank you for your time. How long have you been using Dermovia?

HCP: I've been prescribing Dermovia for about 10 months now. I have roughly 25 patients currently on it, and overall, I'm satisfied with the results.

Interviewer: What made you start using it?

HCP: "The quarterly dosing was the main draw. I have a lot of older patients who struggle with frequent self-injections." I also liked the efficacy data - the PASI 90 rates were competitive with ixekizumab, which I'd been using quite a bit. Plus, the drug rep was very proactive about helping with prior authorizations, which matters in community practice where we don't have huge support staff.

Interviewer: How does it compare to other biologics you use?

HCP: In terms of pure efficacy, I'd put it on par with secukinumab and ixekizumab, maybe a notch below brodalumab. "Where Dermovia wins is convenience. I've had patients switch from every-two-week injections to every-12-weeks, and they absolutely love it." The compliance improvement is dramatic. I used to have patients missing doses, forgetting to refill, running out while traveling. With quarterly dosing, those issues are largely eliminated.

Interviewer: What about side effects?

HCP: Pretty standard for the class. Candida infections are the most common issue - I've had maybe 6-7 patients out of 25 develop oral thrush or vaginal yeast infections. Upper respiratory infections happen but no more than what I saw with other IL-17s. "I did have one patient develop what appeared to be new-onset Crohn's disease about five months into treatment. We stopped Dermovia immediately and referred to GI. That patient is now on infliximab for the Crohn's and ironically, his skin also cleared."

Interviewer: Do you screen for IBD risk before starting?

HCP: I do now. After that case, I'm much more careful about asking GI history. If anyone has chronic diarrhea, abdominal pain, or family history of IBD, I steer them away from IL-17 inhibitors toward an IL-23 or TNF-alpha inhibitor instead. "It's probably only 5-10% of my potential candidates, but for those patients, the IBD risk isn't worth it."

Interviewer: How's the prior authorization process?

HCP: Hit or miss. Maybe 50% get approved within a week with no issues. The other 50% require peer-to-peers, additional documentation, sometimes multiple appeals. "I had one patient where it took seven weeks and three denials before we finally got approval. By that point, the patient was so discouraged he almost gave up." The manufacturer's hub services help, but ultimately, insurance makes the final call.

Interviewer: Do you use the copay assistance program?

HCP: Yes, religiously. For commercially insured patients, the copay card brings their cost down to $25 or less per injection. That's critical for adherence - if patients are paying $500-1000 out of pocket, they'll skip doses or discontinue. The challenge is the Medicare patients who don't qualify for assistance. "I've had to get creative with those patients - applying to charitable foundations, manufacturer PAPs, sometimes they just can't afford it and we have to use a cheaper alternative."

Interviewer: What's your first-line biologic for newly diagnosed moderate-to-severe psoriasis?

HCP: It depends on insurance coverage, honestly. If everything's equal, I lean toward IL-23 inhibitors like risankizumab for patients over 60 or with cardiovascular risk factors - the safety profile seems cleaner. For younger, healthier patients who want rapid results, I'll use an IL-17 like Dermovia or ixekizumab. "The IL-17s work faster - you're seeing dramatic improvement by week 4-6, whereas IL-23s can take 12-16 weeks for maximal effect."

Interviewer: How long do patients stay on Dermovia?

HCP: My longest patient has been on it for about 10 months - which makes sense since I only started using it 10 months ago. So far, retention has been good. I've only had 2 patients discontinue out of 25 - one due to the suspected Crohn's case I mentioned, and one because she moved out of state. No secondary loss of response yet, but I know that's a risk with all biologics over time.

Interviewer: What do you monitor while patients are on treatment?

HCP: I do baseline labs - CBC, CMP, hepatitis B and C, TB testing. Then I recheck CBC and CMP every 6 months. I see patients in person at weeks 4, 12, and 24, then every 6 months if stable. At each visit, I calculate PASI, photograph the skin, and review a symptom checklist for infections, GI issues, mood changes, anything concerning.

Interviewer: How do you measure success?

HCP: PASI 90 is my goal. If a patient gets there by week 16 and maintains it, I consider that a success. I'm seeing that in about 65-70% of my Dermovia patients, which is solid. "The other 30-35% either plateau at PASI 75 or don't respond adequately, and I switch them to something else." I don't let patients languish on an ineffective medication - if they're not at least PASI 75 by week 16, I move on.

Interviewer: Have you had issues with injection site reactions?

HCP: Yes, that's probably the most common complaint. Maybe 30% of patients report redness, swelling, or itching at the injection site. It's usually mild and self-limited, but it bothers some patients. "One patient said the injection site itched so badly she'd scratch it raw, so we switched her to a different biologic." For most, though, it's a minor annoyance they're willing to tolerate for clear skin.

Interviewer: What about special populations - patients with comorbidities?

HCP: I'm cautious with patients who have active infections, obviously - we wait until those clear before starting. Patients with heart failure are also a concern with TNF-alpha inhibitors, so I lean toward IL-17 or IL-23 for them. "For patients with hepatitis B, we need to make sure it's well-controlled before starting any biologic." Diabetes is common in my psoriasis population, and that doesn't change my prescribing - if anything, clearing their skin can improve insulin sensitivity and glucose control.

Interviewer: Do you treat scalp or nail psoriasis with Dermovia?

HCP: Yes, and it works quite well. Scalp psoriasis is particularly responsive to IL-17 inhibition - I'm seeing probably 80% of patients get significant scalp clearance. Nail psoriasis takes longer, which I tell patients upfront. "You need 6-9 months to see nails fully clear because the nail has to grow out. But I am seeing improvement in pitting, onycholysis, and nail bed involvement."

Interviewer: Any concerns about long-term safety?

HCP: The longest safety data we have on IL-17 inhibitors is maybe 8-10 years now with secukinumab. So far, the signals have been reassuring - infection risk stays relatively stable, no unexpected malignancies or major organ toxicity. But we're still learning. "I tell patients we're committed to monitoring them closely, and if new safety signals emerge, we'll adjust accordingly. That's part of using newer medications."

Interviewer: Would you prescribe Dermovia to a family member?

HCP: Yes, if they had moderate-to-severe psoriasis and it was the right fit based on their insurance and preferences. It's a good drug. Not perfect, but good. "The efficacy is there, the safety is manageable, and the dosing convenience is a real differentiator." I'd feel comfortable recommending it.

Interviewer: What would make Dermovia better?

HCP: Honestly? Easier access. If we could get universal coverage without prior auth, that would be transformative. Maybe a higher PASI 100 rate would be nice, but 30-40% complete clearance is reasonable. "The bigger issue is getting patients on therapy quickly without the insurance runaround." Every week of delay is another week of suffering for the patient.

Interviewer: Any final thoughts?

HCP: Just that we're fortunate to have so many effective options now. Twenty years ago, psoriasis treatment was pretty dismal. Now we have a whole arsenal of biologics that can dramatically improve patients' lives. Dermovia is a welcome addition to that arsenal, and I'm glad to have it as an option for my patients.