Practical compendium for psoriasis management

Ibrahim, Samia; Amer, Mohamed A.; Nofal, Hagar; Abdellatif, Ahmed

doi:10.1111/dth.13243

Cited by 8 publications

(13 citation statements)

References 61 publications

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“…However, until very recently, there have been no economic restrictions on the selection of biologic drug once the decision is made to move from conventional to biologic antipsoriatic treatment. Because this may not be the case in other countries, 44 our results offer a nonbiased, real‐world analysis of outcome and the persistence of biologic treatments independent of insurance guidelines. The fact that gender and biologic non‐naïvety affects drug survival rates in a similar fashion for all biologic treatments (independent of the type of drug) may help both patients and clinicians in treatment decision‐making.…”

Section: Discussionmentioning

confidence: 99%

Biologic drug survival rates in the era of anti‐interleukin‐17 antibodies: a time‐period‐adjusted registry analysis*

et al. 2021

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Summary Background Drug survival rates reflect efficacy and safety and may be influenced by the availability of alternative treatment options. Little is known about time‐dependent drug survival in psoriasis and the effect of increasing numbers of biologic treatment options. Objectives To determine whether drug survival is influenced by the availability of treatment options and by factors such as gender, psoriatic arthritis or previous biologic treatment. Methods This observational, retrospective, multicentre cohort study analysed data from patients registered in the Austrian Psoriasis Registry (PsoRA) who were treated with biologics between 1 January 2015 and 30 November 2019. Results A total of 1572 patients who received 1848 treatment cycles were included in this analysis. The highest long‐term Psoriasis Area and Severity Index improvement was observed after treatment with ixekizumab, followed by ustekinumab and secukinumab, adalimumab and etanercept. Overall, ustekinumab surpassed all other biologics in drug survival up to 48 months. However, when adjusted for biologic naïvety, its superiority vanished and drug survival rates were similar for ixekizumab (91·6%), secukinumab (90·2%) and ustekinumab (92·8%), all of them superior to adalimumab (76·5%) and etanercept (71·9%) at 12 months and beyond. Besides biologic non‐naïvety (2·10, P < 0·001), the introduction of a new drug such as secukinumab or ixekizumab (relative hazard ratio 1·6, P = 0·001) and female gender (1·50, P = 0·019) increased the risk of treatment discontinuation overall, whereas psoriatic arthritis did not (1·12, P = 0·21). Conclusions The time‐dependent availability of drugs should be considered when analysing and comparing drug survival. Previous biologic exposure significantly influences drug survival. Women are more likely to stop treatment.

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Section: Discussionmentioning

confidence: 99%

Biologic drug survival rates in the era of anti‐interleukin‐17 antibodies: a time‐period‐adjusted registry analysis*

et al. 2021

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“…Since psoriasis presents subtle inflammation even during remission phases, 19 there was a high level of consensus on the need to provide long‐term proactive topical treatment to reduce the risk of relapse in patients with mild‐to‐moderate psoriasis and prolong time free from disease, in line with current practice in atopic dermatitis 20,21 . Furthermore, according to the Panel, long‐term topical treatment can have a role in the treatment of challenging disease sites on which systemic treatment is often not fully effective, such as the hands, elbows, and scalp 22,23 . In addition, according to the Panel, topical long‐term proactive treatment of psoriasis can be useful when phototherapy or systemic treatment are contraindicated or ineffective, two conditions that may be frequently encountered in clinical practice 24,25 .…”

Section: Discussionmentioning

confidence: 99%

Long‐term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach

et al. 2022

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Background Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on nonconsecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis.Methods A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process.Results Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses.Approaches to improve adherence, on the other hand, need further investigation. ConclusionsThe inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

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“…According to the international consensus decision, moisturizers and low-medium potency corticosteroids are recommended as the fi rst option in the treatment of psoriasis during pregnancy [7,49]. While the uses of topical high potency steroids and topical calcipotriol are not recommended in this period, these topical agents can be used especially from the 3rd trimester [50][51][52][53][54].…”

Section: Pregnancy Course In Patients With Psoriasismentioning

confidence: 99%

“…Methotrexate is one of the wellknown agents that should be avoided both during pregnancy and lactation due to its mutagenic, teratogenic and abortogenic properties. Psoralen + Ultraviolet A (PUVA) therapy should also not be preferred during both pregnancy and lactation due to mutagenic potential of psoralens [7,9,[51][52][53][54]. However, it has been suggested that topical PUVA therapy for palmoplantar psoriasis may be relatively safer, especially from the 3rd trimester [9].…”

Section: Pregnancy Course In Patients With Psoriasismentioning

confidence: 99%

“…The disease, which can exhibit variable clinical appearances and most commonly seen in plaque form, is mild in approximately 85% of the cases and can be controlled by topical treatments and phototherapy. On the other hand, moderate or severe psoriasis occurs in 15% of cases, requiring treatment with systemic agents and continuous follow-up, with comorbidities occurring more frequently [7].…”

Section: Introductionmentioning

confidence: 99%

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Interaction of psoriasis and pregnancy: Maternal and fetal outcomes

Akarsu¹

2020

Arch Anat Physiol

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Psoriasis is a chronic immune-mediated infl ammatory disease that affects about 2%-4% of the population. Clinically typical erythemato-squamous papules and plaques of different sizes and shapes on the skin are characterized by the parallel appearance of epidermal hyperproliferation, infl ammation and angioneogenesis. Although many factors are blamed in the etiology of psoriasis, genetic and environmental factors play a role in the pathogenesis of the disease. However, there may be fl uctuations in psoriasis activity by hormonal changes and pregnancy. Overall, three out of every four psoriasis patients experience a change in the course of the disease during pregnancy. The proportion of those with improvement in the course of psoriasis is about twice as high as those with worsening. However, generalized pustular psoriasis of pregnancy seen in the last trimester of pregnancy can lead to serious maternal and neonatal morbidities and even mortality. On the other hand, some complications such as low birth weight, preterm birth, gestational diabetes, gestational hypertension, preeclampsia and emergency cesarean section have been reported more frequently in pregnant patients with severe psoriasis. Therefore, considering the adverse maternal and fetal outcomes of severe psoriasis and the fetal side effects of systemic psoriasis treatments, psoriasis in pregnant cases should be managed well by keeping the risk-benefi t ratio in balance. In this article, the concerns and misconceptions of the patients with psoriasis about pregnancy and psoriasis interaction, pre-pregnancy counseling, the course of psoriasis during pregnancy, the pregnancy course in patients with psoriasis, and the management of psoriasis in pregnant women have been extensively reviewed, respectively.

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Practical compendium for psoriasis management

Cited by 8 publications

References 61 publications

Biologic drug survival rates in the era of anti‐interleukin‐17 antibodies: a time‐period‐adjusted registry analysis*

Biologic drug survival rates in the era of anti‐interleukin‐17 antibodies: a time‐period‐adjusted registry analysis*

Long‐term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach

Interaction of psoriasis and pregnancy: Maternal and fetal outcomes

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