A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 1

Abstract

IntroductionTraditional clinical trials in psoriasis exclude a significant proportion of patients with complex disease and comorbidities. A consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise to identify difficult-to-treat psoriasis clinical scenarios and to rank treatment approaches.MethodsThe exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting.ResultsSix of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy.ConclusionThe Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with challenging patients with psoriasis.

Impact of effective tumor necrosis factor-alfa inhibitor treatment on arterial intima-media thickness in psoriasis: Results of a pilot study

“…Besides improving skin symptoms, they have recently been suggested to be potentially protective against cardiovascular morbidity. 12,48,49 However, only a few working groups have investigated effects of TNF-alfa blockade on traditional cardiovascular components, 50 so the background of antieTNF-alfa biologics' possible benefit needs further exploration.…”

“…11 However, recent results with TNF-alfa inhibitors in rheumatoid arthritis are promising by showing a reduced number of cardiovascular events. 12 AntieTNF-alfa agents administered in patients with rheumatoid arthritis have been declared to efficiently improve endothelial function (represented by increased flow-mediated vasodilation) 13,14 and significantly decrease carotid intima-media thickness (IMT), 15,16 both accepted indicators of subclinical atherosclerosis. 17 Similarly, a recent study demonstrated significant reduction in aortic inflammation measured by 18 F-fluoro-deoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT), a novel, highly sensitive technique to assess vascular inflammation.…”

Quality Metrics in Neonatal and Pediatric Critical Care Transport

“…The Delphi technique has been a popular method for developing indicators reflecting patient and general practitioner perspectives of chronic illness, performance indicators for emergency medicine, and indicators for cardiovascular disease (6,8,(16)(17)(18)(19). Delphi methodology succeeds in converging agreement, not in ensuring the validity of the results.…”

Use of Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients

“…This novel treatment has a dual mode of action via both cellular necrosis and neutrophil-mediated, antibody-dependent cellular cytotoxicity [74, 75]. Phase III trial data suggested that just two days of field-directed application of 0.05% ingenol mebutate on the trunk and extremities, or three days of field-directed application of 0.015% ingenol mebutate, are significantly more efficacious than vehicle control with respect to complete and partial clearance of lesions [76]. The new product also appears to be well-tolerated and is likely to exhibit high adherence rates given that only a short duration of application is required [77].…”