Comparison of Management Guidelines for Moderate-to-Severe Plaque Psoriasis: A Review of Phototherapy, Systemic Therapies, and Biologic Agents

Ighani, Arvin; Partridge, Arun C R; Shear, Neil H.; Lynde, Charles; Gulliver, Wayne; Sibbald, Cathryn; Fleming, Patrick

doi:10.1177/1203475418814234

Cited by 30 publications

(32 citation statements)

References 35 publications

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“…Psoriasis is a systemic inflammatory disease characterized by a growing body of comorbidities; however availability of targeted anti‐psoriatic therapy has been largely limited (Al‐Mutairi, Al‐Farag, Al‐Mutairi, & Al‐Shiltawy, ; Asa'ad, Fiore, Alfieri, et al, ; Fiore, Leone, Maraolo, et al, ; Jiang, Hinchliffe, & Wu, ; Santus, Rizzi, Radovanovic, et al, ; Yadav, Singh, & Singh, ). More recently, clinicians have been able to better treat psoriasis due to the development of targeted therapy allowing for: (a) second‐step therapy in moderate to severe psoriasis, (b) treatment of moderate to severe psoriasis in patients which have contraindication for traditional systemic drugs and/or (c) treatment of mild psoriasis not responsive to topical treatments (Ighani et al, ). One of the more recently approved targeted therapies is the new Interleukin (IL)‐17 inhibitors (i).…”

Section: Introductionmentioning

confidence: 99%

From randomized clinical trials to real life data. An Italian clinical experience with ixekizumab and its management

Damiani

Conic

Pigatto

et al. 2019

Dermatologic Therapy

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Interleukin(IL)‐17 inhibitors display higher efficacy than both TNFi and IL‐12/23i, which increased the goal psoriasis area severity index (PASI) from 75 to PASI 90 or even PASI 100. Ixekizumab, a recombinant, humanized IgG4 monoclonal antibody targeting IL‐17A displayed a high efficacy and safety in RCTs, namely UNCOVER‐2 and UNCOVER‐3. However, few studies examined real‐life data for these medications, and those which exist highlight discrepancies in efficacy and safety between RCTs and real‐life data, likely due to the heterogeneity of patients treated outside of trials. Thus, we performed a single center large prospective observational study (RLSD) that enrolled 47 psoriatic patients followed for 20 weeks and we compared the obtained data with the UNCOVER studies. At week 20 in RLSD versus UNCOVER‐3 both PASI‐90 and PASI‐100 results were similar, whilst at week 12, the RLSD cohort obtained higher PASI 90 (76 vs 69,3%) and PASI‐100 (55 vs 39%) than UNCOVER cohorts. Interestingly we also reported higher injection‐site related pain that disappeared after week 12. In conclusion, real‐life data together with RCTs contribute to enrich the information background available to dermatologists in daily practice.

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Section: Introductionmentioning

confidence: 99%

From randomized clinical trials to real life data. An Italian clinical experience with ixekizumab and its management

Damiani

Conic

Pigatto

et al. 2019

Dermatologic Therapy

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“…Furthermore, in accordance with recent meta‐analyses, studies and guidelines, TNF inhibitors such as infliximab and adalimumab have been reported to be the most effective drugs prescribed in the presence of PsA and moderate‐to‐severe disease condition. This prescription was also observed at baseline in our semantic map.…”

Section: Discussionmentioning

confidence: 57%

“…The same was true for etanercept that was linked to CKD and TBC. Etanercept, ustekinumab and secukinumab were all connected to a complex history of previous systemic treatments for psoriasis (two or more), moderate disease condition (PASI: [10][11][12][13][14][15][16][17][18][19][20], overweight and university education.…”

Section: Semantic Mapmentioning

confidence: 99%

“…Several treatment options are currently available for the treatment of moderate‐to‐severe psoriasis, including phototherapy, conventional systemic agents, apremilast as well as biological drugs, such as tumour necrosis factor (TNF), interleukin (IL)‐12/23p40, IL‐17 and IL‐23p19 inhibitors . There are multiple guidelines indicating how to use different treatment modalities including phototherapy, conventional systemic agents and biologics for psoriasis …”

Section: Introductionmentioning

confidence: 99%

“…9,10 There are multiple guidelines indicating how to use different treatment modalities including phototherapy, conventional systemic agents and biologics for psoriasis. 11,12 However, the complexity behind patients' characteristics and the choice of treatments in current clinical practice has not been fully described yet.…”

Section: Introductionmentioning

confidence: 99%

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Linkage between patients’ characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss Dermatology Network for Targeted Therapies registry

Cazzaniga

Anzengruber

Augustin

et al. 2019

Acad Dermatol Venereol

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Background Several treatment options are currently available for the treatment of psoriasis. Objective To explore the main associations between patients’ characteristics and systemic treatments prescribed for psoriasis in a large group of patients observed in real‐life clinical practice. Methods This was a retrospective analysis of baseline data collected within the Swiss Dermatology Network for Targeted Therapies registry in Switzerland between March 2011 and December 2017. Semantic map analysis was used in order to capture the best associations between variables taking into account other covariates in the system. Results A total of 549 patients (mean age 46.7 ± 14.7 years) were included in the analysis. Conventional therapies such as retinoids and methotrexate were associated with no previous systemic therapies for psoriasis, a moderate quality of life (QoL) at therapy onset and older age (≥60 years). Fumaric acid derivatives were associated with mild psoriasis (psoriasis area severity index < 10) and long disease duration (≥20 years). On the other side, cyclosporine and psoralen and ultraviolet A/ultraviolet B treatments were linked to a more severe condition, including impaired QoL, hospitalization and inability to work. Regarding biological therapies, both infliximab and adalimumab were connected to the presence of psoriatic arthritis, severe disease condition and other comorbidities, including chronic liver or kidney diseases and tuberculosis. Etanercept, ustekinumab and secukinumab were all connected to a complex history of previous systemic treatments for psoriasis, moderate disease condition, overweight and university education. Conclusions The analysis shows multifaceted associations between patients’ characteristics, comorbidities, disease severity and systemic treatments prescribed for psoriasis. In particular, our semantic map indicates that comorbidities play a central role in decision‐making of systemic treatments usage for psoriasis. Future studies should further investigate specific connections emerging from our data.

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Predicting Clinical Responses to Ustekinumab

Blauvelt

2019

JAMA Dermatol

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In 2019, the efficacy and safety of biologic therapy offer most patients with psoriasis the opportunity to achieve safe and complete or nearly complete clearance of skin lesions. [1][2][3][4] A major obstacle remains across the world, however, in getting access to the best psoriasis medications, owing to high cost and/or lack of adequate health insurance. Indeed, it is commonplace for insurance companies and national regulatory authorities to control use of biologics to reduce overall costs to health care. More specifically, patients with psoriasis often have to experience treatment failure with cheaper, less effective, and less safe nonbiologic drugs prior to gaining access to biologics. 5 The use of older biologics, such as adalimumab and ustekinumab, is often required (because of their lower cost in some settings) prior to using newer biologics that target interleukin (IL)-17A or IL-23, 5 which are generally more effective. [1][2][3][4] Thus, the cost of health care often dictates therapeutic choices, rather than the physician and/or patient choosing what is best for the patient.Understanding which currently available medications will be most effective for treating a given patient with psoriasis is a practice gap for dermatologists, defining an opportunity for both personalized medicine and potential cost savings to the health care system by avoiding step therapy. While nonbiologic therapeutic options and older biologics for psoriasis are generally less effective than newer biologic options, subsets of patients do well with older therapies. [1][2][3][4] For example, 42.0% to 57.6% of patients with psoriasis taking ustekinumab achieve 90% improvement in their Psoriasis Area and Severity Index (PASI 90) at week 16. 1,2,4 If one could understand and predict which patient will respond to an older, cheaper biologic, such as ustekinumab, higher-cost alternatives could be avoided. In this issue of JAMA Dermatology, Tsakok et al 6 report that higher serum drug levels of ustekinumab soon after initiating therapy can predict whether a given patient will respond in the future to ustekinumab. Therapeutic drug monitoring (TDM) like that described in this article is available for ustekinumab 7 and adalimumab, 8 giving dermatologists tools that can help guide early decision-making on whether to keep treating a patient with a given biologic or to switch to another drug.In Great Britain, patients with psoriasis must cycle through methotrexate, cyclosporine, and phototherapy before being treated with a biologic. 5 After this, adalimumab and ustekinumab have been selected as first-line biologics (as designated in the National Health Service formulary), and must be used by patients prior to being treated with a newer more effective anti-IL-17A or anti-IL-23 biologic. [1][2][3][4][5] Tsakok et al 6 examined British patients with psoriasis who were enrolled in

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Comparison of Management Guidelines for Moderate-to-Severe Plaque Psoriasis: A Review of Phototherapy, Systemic Therapies, and Biologic Agents

Cited by 30 publications

References 35 publications

From randomized clinical trials to real life data. An Italian clinical experience with ixekizumab and its management

From randomized clinical trials to real life data. An Italian clinical experience with ixekizumab and its management

Linkage between patients’ characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss Dermatology Network for Targeted Therapies registry

Predicting Clinical Responses to Ustekinumab

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