French guidelines on the use of systemic treatments for moderate‐to‐severe psoriasis in adults

Abstract

These guidelines were developed by the psoriasis research group of the French Society of Dermatology with the aim of providing updated decision‐making algorithms for the systemic treatment of adult patients with moderate‐to‐severe psoriasis. Our algorithms were generated after rigorous evaluation of existing guidelines on the treatment of psoriasis and of publications concerning new systemic treatments, not yet incorporated into existing guidelines. A total of nine existing guidelines and 53 publications related to new systemic treatments were found to meet our criteria for use in the generation of the algorithms. We have proposed two new algorithms to assess therapeutic responses, both of which incorporate emerging criteria for evaluating treatment goals. Updated therapeutic strategy algorithms, incorporating both established and new systemic therapies, were also generated for the treatment of plaque psoriasis and psoriatic arthritis, together with recommendations for the treatment of particular forms of psoriasis and treatment of patients with comorbidities.

Practical compendium for psoriasis management

“…*Methotrexate is the most commonly prescribed medication for psoriasis (Menter et al, ) and recommended as first line by European (Nast et al, ), French (Amatore et al, ), and British (National Institute for Health and Care Excellence, ; Smith et al, ) when phototherapy cannot be used. ^NBUVB is preferred to PUVA except for patients with thick plaques, if response is not satisfactory retinoids can be added (Amatore et al, ). ^^Recurrence of ≥50% of the baseline disease severity within 3 months of completion of therapy that cannot be used on long‐term basis.…”

“…**Canadian and Italian guidelines consider biologics first line since they have better long‐term safety profile regarding organ toxicity (Gisondi et al, ; S. Hsu, ; Alexander Nast et al, ). European, German, French and British guidelines use biologics as second line for patients with psoriasis indicated for systemic therapy if the abovementioned criteria are met (Amatore et al, ; Nast et al, ; A. Nast et al, ; National Institute for Health and Care Excellence, ; Smith et al, ). Latin American psoriasis society guidelines recommend biologics for patients value short‐term effectiveness (Kogan et al, ).…”

“…In Latin guidelines it is a first option biologics for cases need short‐term efficacy (Kogan et al, ). French and British guidelines put adalimumab or ustekinumab as first line before secukinumab (Amatore et al, ; Smith et al, ). $ Acitretin is not recommended as monotherapy for induction of remission and better to be in combination (Amatore et al, ; A. Nast et al, ).…”

“…French and British guidelines put adalimumab or ustekinumab as first line before secukinumab (Amatore et al, ; Smith et al, ). $ Acitretin is not recommended as monotherapy for induction of remission and better to be in combination (Amatore et al, ; A. Nast et al, ). ∞ Fumarates are considered first line therapy in German guidelines (A. Nast et al, ).…”

“…Infliximab should be reserved for patients with very severe disease or if other biologics are contraindicated or cannot be used (Smith et al, ). €€ Apremilast can be saved as a last resort taking in consideration its low efficacy compared to biologics, the risk of some potentially severe adverse events (Amatore et al, )…”