Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Abstract

Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

Psoriasis Area and Severity Index response in moderate‐severe psoriatic patients switched to adalimumab: results from the OPPSA study

“…These temporal differences remain to be examined further in a larger sample size with longer follow‐up to ascertain whether the presence of early metabolic and late articular involvement may play an important role in the therapeutic management of these patients. Taken together, these results confirm that adalimumab is a valid therapeutic option for the management of severe‐to‐moderate plaque psoriasis (with or without psoriatic arthritis), as recommended by National guidelines and International guidelines …”

“…In cases of inadequate response, contraindication or intolerance to at least one DMARD, a therapy with a biologic drug such as tumour necrosis factor (TNF)‐alpha inhibitors (e.g. adalimumab, infliximab or etanercept) or anti‐interleukin therapies (ustekinumab, secukinumab, ixekizumab and brodalumab) is recommended . Although these treatments are effective in treating psoriasis (without severe adverse events), between 10% and 30% of patients show inadequate response, necessitating switching to a second‐line biologic .…”

Elderly psoriatic patients under biological therapies: an Italian experience

“…Recently, Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis included also treatment recommendations for special psoriasis population, as elderly patients. The authors agreed that, for elderly patients requiring a systemic treatment, all therapy, including biologics, can be safely used, as long as they are appropriately screened and monitored …”

Practical compendium for psoriasis management

“…^^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, ). € Secukinumab is considered first line in Italian (Gisondi et al, ), German (A. Nast et al, ), and Latin guidelines. In Latin guidelines it is a first option biologics for cases need short‐term efficacy (Kogan et al, ).…”