Psoriasis, Treatment, Biologic agents, Survey, Dermatologists. According to approved summaries of product characteristics for the different biologics available to treat moderate to severe plaque psoriasis, biologics are considered second-line treatments for use by patients who have contraindications for a standard systemic treatment (including ciclosporin, methotrexate, and psoralen UV-A treatment) or who have not responded to such treatment. Experience in the management of patients with moderate to severe plaque psoriasis. 3. Published guidelines are a point of reference, providing the dermatologist with a summary of the currently available evidence that can facilitate optimal treatment of a patient; they can also serve as a point of reference for hospital managers and health authorities. Published studies suggest that a number of patient and clinical factors could affect the relative cost-effectiveness probabilities of individual nonbiologic and biologic therapies, including the extent to which treatments reduce hospitalizations and patient weight (for weight-based treatments such as cyclosporine, infliximab and ustekinumab). For chronic plaque psoriasis without psoriatic arthritis, most evidence-based clinical practice guidelines recommend biologics as second-line therapies after trials of conventional systemic agents. Treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy (2008): When other systemic therapies are medically less appropriate. For moderate-to-severe psoriasis, ultraviolet B phototherapy is preferred. Despite limited safety data, biologics are favored over other systemic medications when needed.
According to evidence-based guidelines, systemic drugs are treatments of choice for patients with moderate-to-severe psoriasis 13, 16. In most countries, first-line systemic treatment includes methotrexate, ciclosporin A and retinoids, whereas the second-line treatment is based on the biologics infliximab, etanercept, ustekinumab and adalimumab for plaque type psoriasis and psoriatic arthritis, and golimumab for psoriatic arthritis. Patients with moderate or severe psoriasis are included in PsoBest, when treatment with a conventional systemic agent or biologic is started for the first time. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. USA for the treatment of moderate to severe Crohn’s disease (CD) in children. Additional indications for adalimumab approved by the US Food and Drug Administration (FDA) in adults include rheumatoid arthritis as of 2002, psoriatic arthritis as of 2005, ankylosing spondylitis as of 2006, and plaque psoriasis as of 2008. Adalimumab has to date been most often used as a second line anti-TNF- agent when there has been a loss of response to infliximab because of development of neutralizing antibodies or when other infliximab-specific side effects have developed. To provide up-to-date, evidence-based recommendations on use of biologic therapies (infliximab, adalimumab, etanercept, ustekinumab) in adults and children with all types of psoriasis and, where relevant, psoriatic arthritis, for clinical staff involved in the care of patients treated with biologic therapies.
Drug Safety Of Systemic Treatments For Psoriasis: Results From The German Psoriasis Registry Psobest