Incorporating Patient Lifestyle into Treatment Decisions in a 64-Year-Old Man with Late-Onset Psoriasis

EP: 1.Personalizing Psoriasis Treatment and Site-of-Care Decisions

EP: 2.Managing Psoriasis in a 72-Year-Old Woman through In-Office Biologic Administration

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EP: 3.Incorporating Patient Lifestyle into Treatment Decisions in a 64-Year-Old Man with Late-Onset Psoriasis

The second case study features a 64-year-old man with moderate plaque psoriasis who was diagnosed at age 60. The psoriasis affects 10% of his body surface area, primarily on his back. This recently retired patient and his wife are frequent travelers who find topical treatments messy and difficult to apply, often forgetting medications during travel. His medical history includes hyperlipidemia, hypertension, and obesity, representing typical comorbidities seen in patients with psoriasis approaching Medicare age.

Noor identifies several key challenges in this case, including the patient’s active retirement lifestyle, upcoming Medicare transition, and late-onset psoriasis. Late-onset plaque psoriasis can be more challenging to control, making biologic therapy the most appropriate choice. The patient’s frequent travel necessitates a treatment regimen with minimal lifestyle interference and less frequent dosing schedules, making 12-week dosing intervals ideal for maintaining treatment adherence.

Dosing frequency plays a crucial role in treatment success, particularly for busy professionals and active retirees. Noor explains that patients working 60 to 80 hours per week in New York City benefit significantly from less frequent dosing schedules. The transition from commercial insurance to Medicare requires careful planning to ensure treatment continuity. Tildrakizumab offers advantages for this transition, providing consistent coverage options and enabling patients to avoid gaps in therapy. Noor advises patients to avoid Medicare Advantage plans due to formulary restrictions and prior authorization challenges.