EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations

Abstract

This evidence‐ and consensus‐based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The first part of the guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline. Suggestions for disease severity grading and treatment goals are provided. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs. The treatment options discussed in this guideline are as follows: acitretin, ciclosporin, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab.

IL‐17A inhibitors in patients with chronic plaque psoriasis and history of malignancy: A case series with systematic literature review

“…Dermatologists may be hesitant to initiate IL-17A inhibitor in patients with history of malignancy because of possible increased risk of recurrence or progression. 1,2 In that case a lawsuit can be arisen, and the dermatologist could fear about a possible legal revenge. 11 In case of recent history of malignancy, European guidelines recommend topical therapies, acitretin and/or nb-UVB phototherapy (except for high risk of skin cancer) as first line, and methotrexate or apremilast in the case of inadequate response.…”

“…11 In case of recent history of malignancy, European guidelines recommend topical therapies, acitretin and/or nb-UVB phototherapy (except for high risk of skin cancer) as first line, and methotrexate or apremilast in the case of inadequate response. 1 However, these therapeutic options may not be adequate for every patients because of inefficacy and/or low tolerability. 12 Regarding IL-17 inhibitors, American and European guidelines suggest that they are not absolutely contraindicated and can be used in patients with a previous history of malignancy on a case-bycase basis and with a shared decision with an oncologist.…”

“…12 Regarding IL-17 inhibitors, American and European guidelines suggest that they are not absolutely contraindicated and can be used in patients with a previous history of malignancy on a case-bycase basis and with a shared decision with an oncologist. 1,13 Paradoxically, dermatologists may be less concerned about using biologics in patients with advanced/metastatic malignancy because the quoad vitam prognosis depends mainly on the advanced stage of the neoplasm rather than the biologic itself. Given the poor prognosis, it may be appropriate to treat severe psoriasis and improve the quality of life as much as possible.…”

Network meta‐analysis of biologic treatments for psoriasis using absolute Psoriasis Area and Severity Index values ≤1, 2, 3 or 5 derived from a statistical conversion method

“…1 More recently, improvement of 90% or better with respect to baseline PASI (PASI90) is considered as treatment success by the European Medicines Agency 2 and the latest guidelines are shifting away from percentage reduction and towards a target outcome. 3 Any relative (percentage) improvement measure will relate to a baseline value. For different baseline severities, the same relative improvement may therefore indicate very different outcomes.…”

“…In patients with a PASI 50 but not PASI 75, the Dermatology Life Quality Index (DLQI) should be used as a treatment decision‐making tool 1 . More recently, improvement of 90% or better with respect to baseline PASI (PASI90) is considered as treatment success by the European Medicines Agency 2 and the latest guidelines are shifting away from percentage reduction and towards a target outcome 3 . Any relative (percentage) improvement measure will relate to a baseline value.…”