Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Dermatologists may choose from various conventional and biological systemic agents to treat patients with moderate-to-severe psoriasis. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the efficacy of systemic treatment approved for moderate-to-severe psoriasis. Nonbiologic systemic therapies may be effective but can be associated with significant short-term and long-term adverse events (hepatotoxicity, nephrotoxicity, hypertension, dyslipidemia, malignancy, and teratogenicity). Based on the results of their meta-analysis, the authors concluded that the efficacy of systemic agents approved for moderate-to-severe psoriasis likely differ considerably between biologic and nonbiologic agents, as well as within the two classes. The objective of this comparative effectiveness review (CER) is to examine the benefits and harms of biologic systemic agents compared with nonbiologic systemic agents or phototherapy in patients with chronic plaque psoriasis. Data are limited on the efficacy of biologic agents other than infliximab for the treatment of erythrodermic psoriasis. In a systematic review, calcipotriene and calcitriol were equally effective 24.
In the area of biological drug treatments for patients with psoriasis, several comparative studies have already dealt with the effectiveness of these agents 1 5, but no such studies have been conducted about their safety 6. Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment. A number of biologics have been introduced for treating moderate to severe psoriasis. Patients with moderate to severe psoriasis (defined as involvement of greater than 5 body surface area or involvement of 5 body surface area affecting sensitive areas or areas that significantly impact daily function (e. The Review Manager 5.1 (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark, 2011) was used for meta-analysis. In addition, this review will discuss efficacy and safety factors to consider when selecting biologic agents for disease management. Although other systemic therapies are available, treatment has evolved with the biologics. The first biologic agents to be used to treat moderate-to-severe psoriasis were TNF alpha antagonists.
The assessment found that the general efficacy of adalimumab, alefacept, etanercept, infliximab, and ustekinumab for the treatment of moderate to severe plaque psoriasis was supported by multiple good to fair randomized controlled trials. These researchers performed a systematic search for all entries in PubMed, CINAHL, Cochrane Review, and EMBASE related to combination treatments for psoriasis through July 2010. Efficacy and Safety of Systemic Long-Term Treatment for Moderate to Severe Psoriasis. Treatments for moderate-to-severe psoriasis often do not meet patient and physician expectations due to adverse effects, lack of long-term efficacy, and inconvenient administration schedules. Fifty-one articles written in English published between 2001 and 2015 were evaluated and 41 were used in this review. Non-biologic systemic therapies, taken orally or by injection, can be used for patients with moderate-to-severe psoriasis who have not improved from other methods of treatment.
Subcutaneous Biological Treatments For Moderate To Severe Psoriasis: Interpreting Safety Data By Network Meta-analysis
Psoriasis, biologic agents, guidelines, treatment, etanercept, adalimumab, infliximab, efalizumab, biologic therapy. A systematic review of treatments for severe psoriasis. Efalizumab for patients with moderate to severe plaque psoriasis: a randomized controlled trial. Update on New and Emerging Therapies in the Management of Psoriasis. Food and Drug Administration for the treatment of moderate to severe psoriasis. However, despite the availability of these and newer biologic agents, many patients who could benefit from systemic treatment are not achieving adequate control of. Psoriasis Psoriasis is a common chronic inflammatory disease of the skin with an average age of onset between 15-25 years. The long-term safety of the injectable biologic agents, which target inflammatory cytokines, has also been questioned, and their treatment response often decreases over time6., Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment. Psoriasis treatment goals for moderate to severe plaque psoriasis PASI 10 or PASI 10 and DLQI 10 Treat with non-biologic systemic therapy and/or phototherapy. change in PASI score compares PASI score at treatment initiation to PASI score at treatment review. Infliximab is an anti-TNF- drug widely used for the treatment of psoriasis.