DERM on RheumNow PODCAST (April 2026) Save

Welcome to the Derm RheumNow podcast for April 2026. Hi, I'm Dr. Jack Cush, executive editor of RheumNow.com. Derm RheumNow is a monthly podcast for dermatologists and skin-adjacent HCPs who want to look at the intersection of dermatology, rheumatology, inflammation, and 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 can 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 RheumNow podcast that comes out every Friday. This one on Derm comes out once a month.

This week on the April 2026 Derm RheumNow podcast, we're going to talk about MDA5, follow the money, and combination biologics.

Let's begin with MDA5. A Chinese study did a target emulation trial, which is sort of like taking a lot of data and modeling it and looking at the outcomes. This is sort of a new thing in trying to approximate real-world data. So they looked at MDA5 dermatomyositis patients who also had ILD. As you know, MDA5 is a bad subset of dermatomyositis — very aggressive, very unusual, non-traditional skin disease — and they have a significant risk of progressive lung disease, usually different than others with autoimmune disease because it responds to therapy. Anyway, they looked at JAK inhibitor treatment of their patients: 106 treated with upadacitinib, 328 with tofacitinib, and the six-month outcomes as measured by the need for lung transplant. That's obviously a severe endpoint, but transplant-free survival was 72% or 67% with upa versus tofa respectively. Upa was non-inferior to tofacitinib. This is data that suggests the 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 billion, up from 2.1 billion 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-23 endeavors. Number one, Skyrizi, 440 million. Number two, Tremfya, 431 million. And number three, Rinvoq, 376 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. The bad news was that rheumatology was in the bottom four of all physician salaries, but dermatology is in the top 10 — though you're only number 10, and I think that might be disappointing. The average dermatology salary in 2025 was $448,000 according to Medscape, and they surveyed many thousands of physicians — I think it was actually 37,000 MDs who did a 10-minute survey — and 2% of whom were dermatologists. Bad news is that your salaries are expected to go down 1% in 2026. I think it was something like 10 subspecialties or specialties expected their salaries to go up in 2026. Rheumatology made $284,000 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 in scleroderma. This report that I put up showed that it's not related to disease duration. A study of 2,100 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 again of over 2,100 patients; they were 87% female, mean age 55, 40% had diffuse systemic sclerosis. Itch was not related to disease duration. Itch was moderate in severity, four out of 10, and seen in about 35% 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'll be a report on a future podcast.

Uh there's the Asia-Pacific Lupus study that looked at mucocutaneous activity in over 4,000 patients with lupus. How many you think had mucocutaneous activity? Asia-Pacific lupus — they tend to have bad lupus — do they not? Only 36%, with 155 having rash, 731 having alopecia, mucosal ulcerations 352 of that, and that's out of 4,100 patients. Uh only 15% 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. Um it's a complication of systemic sclerosis, also dermatomyositis. This particular study from the EUSTAR database of over 7,100 systemic sclerosis patients — uh 12% had calcinosis cutis at baseline. Uh and another 40% developed calcinosis cutis within 5 years. 46% cumulatively by 10 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 ischemia meaning ulcers, um advanced capillary nail fold capillaroscopy changes, um advanced joint disease, friction rub, synovitis, GI involvement, pulmonary artery hypertension and renal crisis were all more likely to have calcinosis cutis. What we've learned um is that you know the best way to manage that really is surgery. There really really is no great uh drug that manages it. You might have your concoction, please share it with me, but all the experts on this say the best thing you can do is get involved with a um plastic surgeon or someone who can remove those lesions.

Um also looking at labs, they were more likely to have anti-centromere antibodies, anti-PM-Scl antibody positivity — that's interesting — um and again uh long disease duration, diffuse disease, females, telangiectasias, digital ulcers were the ones who are going to get into trouble with calcinosis.

The AFFINITY study is a study that was published this month, uh a combination trial in psoriatic arthritis. It was a pilot um combo of guselkumab plus golimumab 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, there are a number of combination trials going on. There's the VEGA trial in Crohn's disease, there's a few going on in psoriasis right now. Uh and they're all looking good. You know, when the TNF inhibitors came out and then the IL inhibitors came out, we did combination trials — A, it didn't have any additive effect and B, it had more side effects, mainly serious uh 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 uh in progress and starting to be reported.

A lot of good data came out of uh AAD this past month. There was a new TYK2 inhibitor that was presented. There were two phase three trials — the ONWARD 1 and ONWARD 2 studies — of a new TYK2 inhibitor called 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 apremilast — 1,700 patients with moderate to severe 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.

Uh we like arthritis data. I know it might bother you, but a study of psoriatic um arthritis patients — I'm sorry, psoriasis patients — tested annually, over a thousand of them, um they found rheumatoid factor positivity in 5% at baseline and over time in 16%. 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 47% reduction — and increases the odds of biologic DMARD discontinuation, odds ratio 2.6 fold higher um than those who are seronegative for rheumatoid factor.

A few big reports came out this week um uh from JAMA Dermatology. The National Psoriasis Foundation put a primer out on GLP-1 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-1 receptor agonist? The report comes from Dr. Sheth Marola, Britney Weber, Sumaya Reddi, Jeffrey Cohen, Andrew Blauvelt, a lot of big names. Great paper, good review, but will you use GLP-1s? I'm sort of browbeating my rheumatologist into that you probably should. This is great adjunctive therapy, but are you going to do it or are you 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-1 was combined with an IL-17 inhibitor and shown to be highly effective, more so than the IL-17 inhibitor alone, both for the skin disease and for the arthritis. 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 New England Journal. The brepocitinib and dermatomyositis paper published a few weeks ago, two weeks ago in New England Journal — 241 patients with dermatomyositis. They looked at both muscle and skin outcomes. They compared placebo to two different doses of brepocitinib, a JAK inhibitor, and as far as the main primary endpoint, 46% with 30 mg brepocitinib versus placebo at 31%. It was superior across all nine secondary endpoints including skin disease activity, steroid tapering, and functional disability. And again, people like other JAK inhibitors, they respond quick, as quick as four weeks.

Hope you found this information useful. Go to RheumNow.com, sign up to receive more information from us. You can go to the show notes to check out these citations and more. Please be sure to give us a good review because that way we'll keep sending you better and better information. Take care.