Long-term topical management of psoriasis: the road ahead

Segaert, Siegfried; Calzavara‐Pinton, Piergiacomo; Cueva, Pablo de la; Jalili, Ahmad; Danic, Dominique Lons; Pink, Andrew E.; Thaçi, Diamant; Gooderham, Melinda

doi:10.1080/09546634.2020.1729335

Cited by 47 publications

(67 citation statements)

References 57 publications

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“…11 Many patients have a 'phobia' to using corticosteroids as a consequence of potential adverse effects, often leading to patient non-adherence to the treatment regimen. 5,15 Furthermore, there have also been reports of declining efficacy with long-term corticosteroid use. 16 Patient non-adherence to therapy greatly affects the efficacy of long-term topical treatment.…”

Section: Current Approach and Challenges To The Long-term Management mentioning

confidence: 99%

“…2,3 Long-term management of psoriasis is challenging, not only because of the recurrent, relapsing nature of the disease, but also the delay in treatment response and poor patient adherence to treatment that is frequently reported. 4,5 Declining response and non-adherence to therapy can lead to poor outcomes for patients. 4 Thus, a fast-acting treatment, which is patient friendly and can achieve long-term disease control, is needed to help improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…7 Recently, a panel of experts recommended that long-term management should be considered essential to ensure patients receive appropriate proactive treatment, which may help to optimise adherence and improve long-term outcomes for patients. 5 Fixed-dose combination calcipotriol 50 µg/g betamethasone dipropionate 0.5 mg/g (Cal/BD) cutaneous aerosol foam (Enstilar â ; LEO Pharma, Ballerup, Denmark) is approved in the US (in adults and adolescents) and EU (in adults) for the treatment of psoriasis vulgaris for 4 weeks. 8,9 The Phase III PSO-LONG study (NCT02899962) assessed the efficacy and safety of longterm (52 weeks), twice-weekly proactive management with topical Cal/BD foam versus vehicle foam (reactive management with Cal/BD foam as rescue treatment) in the prevention of disease relapse in adults with psoriasis.…”

Section: Introductionmentioning

confidence: 99%

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Addressing challenges associated with long‐term topical treatment and benefits of proactive management in patients with psoriasis

Lebwohl

Thaçi

Warren

2021

Acad Dermatol Venereol

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The majority of patients with psoriasis vulgaris (chronic plaque psoriasis) can be treated successfully with short‐term topical therapies. However, long‐term management of psoriasis with topicals is challenging and tends to take a reactive approach to disease relapse, rather than a proactive approach aimed at maintaining disease remission. Patients are often dissatisfied with the delay in treatment response and inconvenience of applying topical treatments, and therefore frequently discontinue treatment leading to poor outcomes. Relapse is common, particularly with reactive management, as underlying residual disease can remain following initial skin clearance; some patients find that their disease at relapse may be worse than their initial symptoms. This can have a detrimental effect on patient quality of life (QoL) and increase the risk of psoriasis‐associated depression. A long‐term proactive management approach, with maintenance treatment following initial treatment success, could help sustain disease remission and improve clinical and QoL outcomes for patients. Treatment with fixed‐dose calcipotriol 50 µg/g betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) is effective in the short term, providing a fast onset of action and improvements in disease at 4 weeks. Results from the Phase III PSO‐LONG study demonstrated that long‐term proactive management was superior to reactive management in prolonging time to first relapse, reducing number of relapses and increasing days in remission in adults with psoriasis vulgaris. Furthermore, Cal/BD foam was well tolerated in PSO‐LONG. No new safety concerns were identified over 52 weeks; the safety profile was consistent with that described previously. Given this, Cal/BD foam should be considered when prescribing topicals for the long‐term proactive management for patients with psoriasis.

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Section: Current Approach and Challenges To The Long-term Management mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Addressing challenges associated with long‐term topical treatment and benefits of proactive management in patients with psoriasis

Lebwohl

Thaçi

Warren

2021

Acad Dermatol Venereol

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“…Although there is a consensus on flare treatment with topical products, a harmonized recommendation is lacking in the guidelines on the type of products (steroid or vitamin D analogs, alone or in combination), and the frequency of administration that would support long-term management for an effective long-term disease control. 2 In addition, most topicals are not approved for longer than the acute phase; only calcipotriol/betamethasone dipropionate (Cal/BD) fixed-dose combinations as gel and ointment and vitamin D analogs have been investigated and approved as treatment for 52 weeks on an as-needed basis. 3 A recent consensus in Asia on the management of mild to moderate plaque psoriasis with topical therapy agreed that the maintenance phase and prevention of relapses could be achieved with twice a week or weekend application of a topical steroid or vitamin D analog or a fixed-dose combination of both.…”

Section: Discussionmentioning

confidence: 99%

<p>Spotlight on Topical Long-Term Management of Plaque Psoriasis</p>

Carrascosa

Theng²,

Thaçi

2020

CCID

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During the 28th Congress of the European Academy of Dermatology and Venereology (EADV) held in Madrid in October 2019, an industry hub was dedicated to the long-term management of psoriasis. Psoriasis is a systemic inflammatory disease primarily involving the skin that affects up to 4% of the European population, the majority of whom present with chronic plaque psoriasis. Topical therapies are well established in the first-line treatment of psoriatic plaque flares. Nevertheless, as psoriasis is a chronic disease, long-term control should be considered. The aim of the session was to provide expert opinion on the benefit of long-term maintenance therapy in chronic plaque psoriasis and introduce the concept of pro-active management to decrease the number of relapses and improve patient quality of life. The current guidelines and recommendations were reviewed, as well as the available data on published clinical trials. There is still an important role for topical therapy in psoriasis and current recommendations suggest a maintenance regimen for psoriasis. Adherence optimization and proactive management of relapse can be key factors for obtaining clinical outcomes in topical long-term therapy. Calcipotriol/betamethasone dipropionate foam is the only topical formulation with long-term data as a twice-weekly proactive treatment approach for up to 52 weeks for chronic plaque psoriasis.

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“…80% of psoriasis patients have mild-to-moderate disease and may be controlled with local therapy only. [8] Moreover, for children, pregnant women, elderly or immunosuppressed patients, systemic therapies implicate unacceptable risks; particularly in life-changing circumstances such as the present SARS-COVID-19 pandemic, patients' acceptance for systemic immunosuppressants considerably decreases. [9,10] Furthermore, effective topical therapies are urgently needed for difficult-to-treat areas such as scalp, nails, intertriginous and palmoplantar regions.…”

Section: Introductionmentioning

confidence: 99%