PowerPoint Presentation Survey Results Identifying Clinician Strategies for Therapy Selection for Common Inflammatory Skin Diseases Disclosures References Results Nicholas D. Brownstone1, Aaron S. Farberg2,3, Ann P. Quick4, Jennifer J. Siegel4, Matthew S. Goldberg4, Peter A. Lio5 1. Temple University Hospital, Philadelphia, PA 2. Baylor Scott & White Health System, Dallas, TX 3. Bare Dermatology, Dallas, TX 4. Castle Biosciences, Inc, Friendswood, TX 5. Northwestern University Feinberg School of Medicine, Chicago, IL Methods › In the absence of a molecular test to help guide therapeutic selection, clinicians currently must make empirical decisions based on personal experience and/or the available population-based evidence, which can lead to delays in disease control and increased cost to the healthcare system. › Clinicians would prefer to have a molecular test to help determine the most efficacious drug for individual patients. › Results from this survey can be used to inform clinical studies such as the prospective IDENTITY study which is currently enrolling patients with psoriasis and atopic dermatitis to use each patient’s molecular data to guide personalized therapeutic selection. ConclusionsObjectives 1) To determine how clinicians currently choose a systemic therapy for patients with moderate-to- severe atopic dermatitis or psoriasis in the absence of routine molecular data and 2) To determine how often the current approach leads to patients switching medications. Changing Systemic Therapy Clinician Interest in Molecular Test 1. Renert-Yuval Y and Guttman-Yassky E. J Am Acad Dermatol. 2020; 124(1):28-35. 2. Armstrong A and Read C. JAMA, 2020;323(19):1945-1960. 3. Kaushik S and Lebwohl M, J Am Acad Dermatol, 2019; 80(1):27-40. 4. Aggarwal P et al, Dermatol Ther 2022; 12, 611-614. 5. Mathur S and Sutton J, Biomed Rep. 2017; 7(1):3-5. › Recent advances in the understanding of the molecular pathways underlying the development of common inflammatory skin diseases including atopic dermatitis (AD) and psoriasis led to the development of multiple novel systemic drugs targeting those pathways.1,2 › As more therapeutics are approved for treatment of AD and psoriasis, it will be important to make informed decisions about each individual patient’s therapeutic plan. › Each patient’s molecular profile can impact the efficacy of a drug for that individual. However, literature suggests that patient comorbidities may be the driving factor for determining systemic medications.3 Further, a low biopsy rate for uncertain inflammatory skin disease diagnoses may lead to incorrect diagnosis and treatment in a subset of patients.4 › A trial-and-error approach to therapy selection could lead to delay in appropriate treatment of AD or psoriasis and increased cost to healthcare systems.5 › Therefore, understanding an individual patient’s disease at the molecular level could better inform treatment decisions. › However, currently, non-invasive molecular tests to guide therapeutic selection are not routinely used for psoriasis and atopic dermatitis. › A 20-question survey was submitted for human subject IRB approval and deemed exempt by Advarra IRB. › The survey was made available to attendees of the Winter Clinical Dermatology 2022 conference. › Participation was voluntary and not associated with additional data presentation; respondents that completed the survey were given monetary compensation. Background › This study was sponsored by Castle Bioscience, Inc. › NDB has no relevant disclosures. › ASF is a consultant for Castle Biosciences, Inc. and on the advisory board for Eli Lilly, Sun Pharma, Ortho Dermatologics, Boehringer Ingelheim, Incyte, Amgen, Galderma, Novartis, Janssen, and Pfizer. › APQ, JJS and MSG, are employees and shareholders of Castle Biosciences, Inc. › PAL reports research grants/funding from AbbVie, AOBiome, Eczema Foundation, National Eczema Association; is on the speaker's bureau for AbbVie, Eli Lilly, Galderma, Hyphens Pharma, Incyte, La Roche-Posay/L’Oreal, MyOR Diagnostics, ParentMD, Pfizer, Pierre- Fabre Dermatologie, Regeneron/Sanofi Genzyme; reports consulting/advisory boards for AbbVie, Almirall, Amyris, Arbonne, ASLAN, Bodewell, Boston Skin Science, Bristol-Myers Squibb, Burt’s Bees, Castle Biosciences, Codex Labs, Concerto Biosci, Dermavant, Dermira, DermVeda, Eli Lilly, Galderma, IntraDerm, Janssen, Johnson & Johnson, Kaleido Biosci, Kimberly Clark, LEO Pharma, Lipidor, L’Oreal, Menlo Therapeutics, Merck, Micreos, MyOR Diagnostics, Regeneron/Sanofi Genzyme, Sibel Health, Skinfix, Sonica, Theraplex, UCB, Unilever, Verrica, Yobee Care; stock options with LearnSkin/Learn Health, Medable, Micreos, Modernizing Medicine, Yobee Care. In addition, Dr. Lio has a patent pending for a Theraplex product with royalties paid and is a Board member and Scientific Advisory Committee Member of the National Eczema Association. Results Respondent Demographics Number years in practice n respondents (%) Resident/ fellow 73 (27.6) 1-10 years 88 (33.2) 11-20 years 42 (15.9) 21-30 years 33 (12.5) >30 years 29 (10.9) Primary specialty n respondents (%) Dermatologist 235 (88.7) Dermpath or Derm/ Dermpath 3 (1.1) NP/PA 19 (7.2) Mohs 1 (0.4) Other specialist 7 (2.6) Practice type n respondents (%) Academic/university 94 (35.4) Group practice 102 (38.5) Multi-specialty group 28 (10.6) Solo practice 40 (15.1) Retired 1 (0.4) Number patients with moderate- to-severe AD or psoriasis / month n respondents (%) 0 5 (1.9) 1-10 88 (33.2) 11-24 100 (37.7) 25-49 41 (15.5) 50+ 31 (11.7) Number biologics prescribed for AD or psoriasis / month n respondents (%) 0 9 (3.4) 1-10 126 (47.6) 11-24 96 (36.2) 25-49 22 (8.3) 50+ 12 (4.5) Factors considered when choosing a first systemic therapy for AD or psoriasis were ranked on a scale from 1-5 from most important (1) to least important (5). Ranked results were compiled and Kruskal-Wallis test was used to detect significant differences. “Reported efficacy” was the highest-ranking factor while “molecular mechanism” ranked lower overall in the current decision-making process (p< .001). Reason for systemic therapy discontinuation Average number systemic therapies needed for efficacy Percent all respondents that would find a molecular test for AD or psoriasis therapy guidance useful “No symptom improvement” was the top reason reported for patient discontinuation of systemic medications for AD or psoriasis. Additionally, 62.3% (165) of clinicians surveyed estimated that, on average, 2 or more systemic therapies were needed to find one that was efficacious indicating that lack of efficacy for individual patients contributes to switching systemic therapies. Greater than 90% (239) of all clinicians responded that they would or would likely find a molecular test for therapeutic selection for psoriasis or AD beneficial. Factors Currently Guiding Therapy Selection Side Effects No Symptom Improvement Financial Burden Insurance Declined Other Slide 1