DERM on RheumNow (April 2026) Save

Welcome to the Derm on Room Now podcast for April 2026. Hi, I'm Doctor. Jack Cush, executive editor of roomnow.com. Derm on Room Now is a monthly podcast for dermatologists and skin deep HCPs who want to look at the intersection of dermatology, rheumatology, inflammation, autoimmunity. We cover the news, research, journal reports, and regulatory announcements that are of import to you and to me.

We cover topics like psoriasis, cutaneous lupus vasculitis, hidradenitis, other CTDs, biologics JAKs, new derm therapeutics, and really look at the sort of practical, real world application of all this information. You can learn more by signing up for RheumNow News, which could come to you either daily by email or weekly by email, or you can sign up to get these podcasts when they come out. We have a RoomNow podcast that comes out every Friday. This one on derm comes out once a month. This week on the April 2026 Derm on RoomNow podcast, we're gonna talk about MDA five, follow the money in combination biologics.

Let's begin with MDA five. A Chinese study did a target emulation trial, which is sort of like taking a lot of data and modelling it and looking at the outcomes, right? There's I mean, this is sort of a new thing in trying to approximate real world data. So they looked at MDA-five dermatomyositis patients who also had ILD. As you know, MDA-five is a bad subset of dermatomyositis.

Very aggressive, very unusual, non traditional skin disease. And then they have a significant risk of progressive lung disease, usually ILD. Different than other ILDs with autoimmune disease because it responds to therapy. Anyway, they looked at JAK inhibitor treatment of their patients: one hundred and six treated with apadacitinib, three twenty eight with tofacitinib, and the six month outcomes as measured by the need for lung transplant that's obviously a severe endpoint but being transplant free survival was seventy two percent or sixty seven percent with upa versus tofa respectively. Upa was non inferior to tofacitinib.

This is data that suggests that JAK inhibitors are effective in dermatomyositis, especially this very difficult to treat MDA5 subset. Keep that in mind. You probably see the ads on television as I do, and it's a bother to a lot of physicians, and patients seem to like it, the FDA likes it, that's why they allow it. Anyway, in 2025 direct to consumer DTC ad spending by the top 10 pharma companies increased significantly to almost 3,000,000,000, up from 2,100,000,000 in 2024. The top three drugs spending money on DTC, two of the three, actually all three of them are yours, but two of the three are clearly yours because they're both IL-twenty three inhibitors.

Number one: SKYRIZI four forty million. Number two: TREMFIA four thirty one million. And number three: RINVOCA three seventy six million. Most of those are for psoriasis and psoriatic arthritis. So you're the cause of all this DTC that drives doctors crazy.

Actually the FDA allows it because the data is pretty clear: while you may not like it, while patients come in wanting to talk to you about shouldn't I be on SKYRIZI for my atopic dermatitis? And you have to explain why no, the FDA and research has shown that patients are more likely to talk to their doctor about conditions they wouldn't normally talk about, and about drug therapy they wouldn't normally talk about, and that's what it's supposed to do: increase patient physician communication. So, speaking of money, Medscape does its annual physician salary reports. The good news is that salaries are up 3% from the year before. These are 2025 salaries.

And the bad news was that rheumatology was in the bottom four of all physician salaries, but the dermatology is in the top 10. But you're only number 10. I think that might be disappointing. The average dermatology salary in 2025 was 448,000 according to Medscape, and they surveyed I think it was, thousands, like, I don't know, many thousands of physicians, 2% of whom were dermatologists. And, it was actually 37,000 MDs did a ten minute survey, and that's what they came up with.

The bad news is that, your salary is you expect your salary to go down 1% in 2026. I think it was something like 10 subspecialties or specialties expected it to go up in 2026. Room, we made 284,000 in 2024 and in 2025 and we expect it to be the same in 2026. Follow the money. Itch is a common problem.

We in rheumatology don't know what to do about it. It's common as scleroderma. This report that I put up showed that it's not related to disease duration. A study of two thousand one hundred patients with systemic sclerosis that actually had over 20,000 surveys and itch assessments. How do you do an itch assessment?

You'll have to teach me that. This study was a study of, again, over two thousand one hundred. They were eighty seven percent female, mean age 55, forty percent had diffuse systemic sclerosis. Itch was not related to disease duration. Itch was moderate in severity four out of ten and seen in about thirty five percent of patients if you look at all visits, all times.

It's a common problem. They only looked at the frequency here they didn't give me any insights as to the management of itch, and hopefully that will be a report on a future podcast. There's the Asia Pacific Lupus Study that looked at mucocutaneous activity in over four thousand patients with lupus. How many do think had mucocutaneous activity? Asia Pacific lupus they tend to have bad lupus, do they not?

Only thirty six percent, with ten fifty five having rash, seven thirty one having alopecia, mucosal ulcerations three fifty two. Of that and that's out four thousand one hundred patients, only fifteen percent had persistent mucocutaneous disease, hence mucocutaneous disease tends to come and go. It tends to be more likely to be associated with being Caucasian, smoking, positive serologies, history of vasculitis, myositis, serositis, nephritis, and neuropsychiatric disease. Bad lupus is going to get you a lot of bad skin disease. I guess that's my takeaway on that.

Speaking of bad skin disease, the thing I don't want to see that I'm sure you're not happy to see is calcinosis. Calcinosis cutis. It's a complication of systemic sclerosis, also dermatomyositis. This particular study from the U Star database of over seven thousand one hundred systemic sclerosis patients, twelve percent had calcinosis cutis at baseline. And another forty percent developed calcinosis cutis within five years, forty six percent cumulatively by ten years.

What was it associated with? It was more frequent in females with longer disease duration, higher Rodnan Skin scores, those who had telangiectasias, digital ischaemia, meaning ulcers, advanced nail fold capillaroscopy changes, advanced joint disease, friction rub, synovitis, GI involvement, pulmonary artery hypertension, and renal crisis were all more likely to have calcinosis cutis. So what we've learned is that, you know, the best way to manage that really is surgery. There really is no great drug that manages it. You might have your concoction, please share it with me, but the all the experts on this say the best thing you can do is get involved with a plastic surgeon or someone who can remove those lesions.

Also looking at labs, they were more likely to have anticentromere antibodies, anti PMSCL antibody positivity. That's interesting. And again, long disease duration, diffuse disease, females, telangiectasia, digital ulcers were the ones who were going to get into trouble with calcinosis. The affinity study is a study that was published this month, a combination trial in psoriatic arthritis. It was a pilot, combo of guselkumab plus galimumab versus guselkumab alone in PSA patients who had previously failed a TNF inhibitor, and showed that the combination had significant superiority as far as ACR50 joint outcomes.

As you know, are a number of combination trials going on: there's the VEGA trial, there's a in Crohn's disease, there's a few going on in psoriasis right now, and they're all looking good. You know, when the TNF inhibitors came out and then the IL-one inhibitors came out, and we did combination trials: A) it didn't have any additive effect, and B) it had more side effects, mainly serious infectious events. In these new combination trials, especially in psoriatic disease, they look to have no greater risk of infection and serious adverse events, and it looks like there is an additive effect of the combination. Of course, right now none of these are FDA approved, but it's good to know that these trials are in progress and starting to be reported. A lot of good data came out of AAD this past month.

There was a new TYK2 inhibitor that was presented. There were two phase three trials of the onward one, onward two studies of a new TYK2 inhibitor called envoducitinib. Envoducitinib. Envoducitinib. Sounds like a chance to rid someone of a demon.

Envoducitinib. Anyway, they found that this drug in phase three trials, both trials, was superior to placebo and also superior to apremolast. Seventeen hundred patients with, monocresevere plaque psoriasis were studied in these trials. I think you'll be seeing another TYK2 inhibitor in the future, although it's not currently FDA approved. We like arthritis data, I know it might bother you, but a study of psoriatic arthritis patients I'm sorry, psoriasis patients tested annually, over a thousand of them, they found rheumatoid factor positivity in five percent at baseline and over time in sixteen percent.

What does that matter? The bottom line is if you have psoriasis and rheumatoid factor positivity, or psoriatic arthritis and rheumatoid factor positivity, one, it reduces the odds of achieving minimal disease activity, MDA, it's a forty seven percent reduction, and increases the odds of biologic DMAR discontinuation odds ratio 2.6 fold higher than those who are seronegative for rheumatoid factor. A few big reports came out this week from JAMA Dermatology. The National Psoriasis Foundation put a primer out on GLP-one receptor agonist therapy in psoriasis. It's an overall review of the subject, the biology, why would this work, why you should use it, what the role as you know, you know, comorbidity is a big issue in psoriasis, psoriatic arthritis, obesity is a big issue.

And the question is: when you use these drugs, do the patients get better because they lose weight, or is it a biologic effect of the GLP-one receptor agonist? The report comes from Doctor. Sheth, Marola, Brittany Weber, Sumaya Reddy, Jeffrey Cohen, Andrew Blaueveldt a lot of big names. Great paper, good review. But will you use GLP-1s?

I'm sort of browbeaten, my rheumatologist, into that you probably should. This is great adjunctive therapy, but are you going to do it or are going to partner with a rheumatologist or partner with an endocrine or obesity specialist to do that? As you know at AAD the Together PSO and Together PSA trials were published where a GLP-one was combined with IL-seventeen inhibitor and shown to be highly effective, more so than the IL-seventeen inhibitor, both for the skin disease and for the arthritis. Those I have the link in the show notes for this. And the last big report for all those who are interested in dermatology topics: dermatomyositis made it into the New England Journal.

The Brepocitinib in dermatomyositis published a few weeks ago, two weeks ago in New England Journal. Two forty one patients with dermatomyositis, and they looked at both muscle and skin outcomes. They compared placebo to two different doses of a JAK inhibitor, a JAK TIC inhibitor, I believe, and as far as main primary endpoint, forty six percent with thirty mg of brepocitinib versus placebo at thirty one percent. So, and it was superior across all nine secondary endpoints including a classy like skin disease activity, steroid tapering, functional disability, and again, people like other JAK inhibitors, they respond quick, as quick as four weeks. Hope you found this information useful.

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