DERM on RheumNow PODCAST (February 2026) Save

Welcome to the DermNow on RheumNow podcast for February of 2026. Hi, I'm Dr. Jack Cush, executive editor of RheumNow.com. The DermNow on RheumNow podcast is curated for dermatologists and skin-deep HCPs where we discuss the intersection of all matters that are relevant to both dermatology and rheumatology. These are items that I pick up and report on on my website and daily newsletter and weekly podcast at RheumNow.com. You can register now. We talk about psoriasis, psoriatic arthritis, cutaneous lupus, vasculitis, hidradenitis, connective tissue disease and the therapies we both use, the biologics, the JAK inhibitors, etc. We like to discuss regulatory decisions and new advances in our field.

Let's begin with a new announcement by the FDA that came about at the beginning of February. This was the FDA sending a complete response letter to AstraZeneca, the manufacturer of anifrolumab, the alpha interferon inhibitor that's approved for use in lupus. They actually just released the TULIP-C trial. This was a trial proving the efficacy of saphnelo anifrolumab in cutaneous lupus using a CLASI-A endpoint. At the same time that this was published in January, the EMA in Europe approved the use of saphnelo for use in cutaneous lupus. And while all these good things are going on, now the FDA comes out with a complete response letter putting a halt to the manufacturer's biologic license application, or BLA, to extend the indications of anifrolumab now to cutaneous lupus. And the FDA, by issuing a complete response letter — we don't know for what reason — is saying, whoa, whoa, whoa, we got to discuss some of the data or some of the findings or something they're not quite happy with. So this is not necessarily a bad thing. It usually is a clarification on information and safety data. And it just sort of puts off the FDA's decision to approve this therapy, which I would expect would happen sometime in the next 3 to 6 months.

Next we have a review on calcinosis cutis, something that really bothers us when we have to manage it. We don't know if we should send it to you, or if you — maybe you don't know if you should send it to us. No one seems to have a really good handle on it. I thought this review was a good one. And what we do know from this review and others is that the most effective measures in managing calcinosis cutis — which is common in systemic sclerosis, common in dermatomyositis including juvenile dermatomyositis, including people who are NXP2 positive — the most effective measures are surgical, and that means excision, curettage, even laser ablation. What's not so good, and often ineffective or incomplete, and may only work with limited disease and early manifestations of calcinosis, are medical measures such as calcium channel blockers, tetracyclines, probenecid, biologics, immunomodulators, colchicine, sodium thiosulfate, and yeah, even JAK inhibitors. I have not tried that. I've tried almost all of those but not JAK inhibitors — again, not really with good effect. But a good relationship with a plastic surgeon is helpful, and maybe you can do this in your office if it's limited disease.

A review of what's going on in systemic sclerosis also appeared this week. As you know, the most frustrating disease that I treat — and hopefully maybe you don't have to treat as much — is systemic sclerosis, and that includes both limited and linear and, you know, localized disease where there's better treatments. But when it gets to be, you know, limited CREST disease or diffuse disease, oh my goodness, it's just a bit maddening. We're starting to get some drugs approved, mainly with a lung indication, and that's good — drugs like nintedanib, the anti-fibrotics, and tocilizumab, the anti-IL-6 drug. But in this review of what's out there in Medline and also at ClinicalTrials.gov, they found 32 trials, 2,000 patients using 23 new targeted therapies, showing positive data for gelab — the IL-23 data — looking at primarily a modified Rodnan skin score. This was better than what was seen with tofacitinib and inebilizumab, a B cell depleter that's approved for use in IgG4-related disease. When looking at lung outcomes, much more frustrating. There was positive data or efficacy when looking at B cell targeted therapies with belimumab or rituximab. These trials that are in development or one-offs are probably early phase 2 or phase 2B trials. We're going to need more studies before we ever get around to them being approved for use in systemic sclerosis.

An outcomes trial looked at 2,400-plus claims data patients and 1,200 patients with EHR data with dermatomyositis, looking at what happens with these people — looked at testing, treatment, and outcomes. As far as testing, half of them had myositis panels done; the other — a third of them had myositis-specific autoantibodies like MDA5, NXP2, TIF1-gamma, etc.
um steroid. But by the way, why aren't more people being tested for anti-synthetase and these myositis autoantibodies? I think they are helpful in management and prognostication. Steroids were common, but only 70% — 74% — were receiving either hydroxychloroquine, methotrexate, or mycophenolate. What? Hydroxychloroquine for dermatomyositis? I hope it's for skin disease because it doesn't do squat for the muscles. Mycophenolate, I'm not impressed with what it does for muscles. Methotrexate, yes. Azathioprine, yes.

And then when they looked at what happens to these people — outcomes, the bad outcomes, the things we worry about — they expressed these as per 1,000 patient years. Think about it this way: a thousand patients followed one year, how many hospitalizations would you see? 92. 92 per 1,000 patient years. What about malignancy? It's only 15 per 1,000 patient years. ILD, myocarditis, 2. So a lot of things we worry about are still pretty rare events in this study.

Looking at psoriasis and what's going on. There's a lot of new reports. The derm bio registry from Denmark looked at the experience of biologic treatment in psoriasis patients. And so this is a registry. They had in this registry 3,790 patients who were biologic naive, and when they looked at the best 5-year survival, what do you think was the best biologic? That's right, the one you didn't expect. Ustekinumab outperformed adalimab and secukinumab. What? Really? I think the reason was that a lot of them were escalated from 45 to 90 milligrams in dosing.

When they looked at 3,400 who were biologic-experienced psoriatic patients, the best performing drugs were what you and I are using — bimekizumab, guselkumab, and risankizumab. Overall, three of these drugs are IL-23 inhibitors — guselkumab, risankizumab, and ustekinumab — two are IL-17 inhibitors. I think we're on the right track.

Real-world retention — that's another thing I like as a measure of success or efficacy and safety. A single-center real-world study of 122 psoriatic arthritis patients looking at specifically secukinumab. You know what influenced retention the most, and significantly so? Smoking. Being a current smoker significantly dropped your retention rates by at least 5%. But you know what didn't? Obesity. There are other studies showing obesity is a factor in lowering retention rates, as is being on prior biologic therapy, as is having peripheral arthritis as opposed to axial arthritis. So overall the significant results were: being a former smoker — 32% higher — and current smoker — 27% higher risk of falling off the drug. And they go off the drug for both efficacy and toxicity reasons, and reasons maybe that are not otherwise explained.

I think the big news this month was the TOGETHER PSO trial. This is a press release from Lilly showing that the combination of ixekizumab and tirzepatide — which is Mounjaro, or I think it's Zepbound — the GLP-1 receptor agonist, excuse me — where they showed the combination of the IL-17 and the GLP-1 was better than the IL-17 alone in treating moderate to severe psoriasis. These are patients who had — on average, the majority had about over 25% body surface area involvement. There are 274 patients. Their primary readout right here is 36 weeks, and the primary endpoint is a PASI 100 plus greater than 10% weight loss. At 36 weeks, the results favored the combination — 27% — over single-drug ixekizumab alone — 6%. Highly significant. If you look at PASI 100 responses alone, not the weight loss, the combination outperformed monotherapy 41% versus 29%. I find that surprising. Again, these people had pretty severe skin involvement by the inclusion criteria. They're going to continue the study, go out to week 52. You'll probably see it at a dermatology meeting coming up before I'll see it at an arthritis meeting.

By the way, this report follows about 2 weeks after Lilly released the TOGETHER PSA trial — another 36-week phase 3B study. This was 271 patients where the combination versus ixekizumab alone. There the primary endpoint was a high-level arthritis endpoint — ACR50 plus greater than 10% weight loss — and the combination therapy outperformed monotherapy 32% to less than 1% at 36 weeks. The same could be said for ACR50 alone. I think this is a very important result and I think it is going to change the way we manage arthritis and the way you manage psoriasis going forward.

There are a lot of trials of these GLP-1 drugs coming down the pipe in the future, and I think they're going to be big. I'd like to know what you think. Sign up for RheumNow at RheumNow.com. We just completed RheumNow Live — if you're interested, we had a whole session on psoriatic arthritis. We had Joe Merola and Arty Kavanaugh and Dr. Rivero and others doing a great session and panel discussion. You can go to RheumNow.live to sign up for that, but it's
probably better to just go to RheumNow, sign up for these — either the emails, the weekly email. You can get a customized email. I only want to hear about psoriatic arthritis stuff or lupus stuff. I think you'll find it useful. Tell your colleagues. Give us a good rating. Take care.