Guidelines of care for the management of psoriasis and psoriatic arthritis

Menter, Alan; Korman, Neil J.; Elmets, Craig A.; Feldman, Steven R.; Gelfand, Joel M.; Gordon, Kenneth B.; Gottlieb, Alice B.; Koo, John; Lebwohl, Mark; Leonardi, Craig L.; Lim, Henry W.; Voorhees, Abby S. Van; Beutner, Karl R.; Ryan, Caitriona; Bhushan, Reva

doi:10.1016/j.jaad.2010.11.055

Cited by 395 publications

(128 citation statements)

References 193 publications

(209 reference statements)

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“…An international consensus report as well as the USA, Europe, and Japan guidelines describe that a short overlap period (e.g. 2–8 weeks) between CyA and biological therapy can be considered in order to reduce the risk of relapse 5, 6, 7, 8, 9. However, co‐administration of CyA and biologics is not recommended because of undesirable immune suppression 6…”

Section: Introductionmentioning

confidence: 99%

Secukinumab improves psoriasis symptoms in patients with inadequate response to cyclosporine A: A prospective study to evaluate direct switch

Ohtsuki

Morita

Igarashi

et al. 2017

The Journal of Dermatology

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There are limited data on the safety and efficacy of switching to secukinumab from cyclosporine A (CyA) in patients with psoriasis. The purpose of the present study was to assess the efficacy and safety of secukinumab for 16 weeks after direct switching from CyA in patients with moderate‐to‐severe psoriasis. In this multicenter, open‐label, phase IV study, 34 patients with moderate‐to‐severe psoriasis and inadequate response to CyA received secukinumab 300 mg s.c. at baseline and weeks 1, 2, 3, 4, 8 and 12. The primary end‐point was ≥75% improvement from baseline in Psoriasis Area and Severity Index score (PASI 75) at week 16. The efficacy of secukinumab treatment was evaluated up to week 16, and adverse events (AE) were monitored during the study. The primary end‐point of the PASI 75 response at week 16 was achieved by 82.4% (n = 28) of patients receiving secukinumab. Early improvements were observed with secukinumab, with PASI 50 response of 41.2% at week 2 and PASI 75 response of 44.1% at week 4. AE were observed in 70.6% (n = 24) of patients, and there were no serious AE or deaths reported in the entire study period. Secukinumab showed a favorable safety profile consistent with previous data with no new or unexpected safety signals. The results of the present study show that secukinumab is effective in patients with psoriasis enabling a smooth and safe direct switch from CyA to biological therapy.

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Section: Introductionmentioning

confidence: 99%

Secukinumab improves psoriasis symptoms in patients with inadequate response to cyclosporine A: A prospective study to evaluate direct switch

Ohtsuki

Morita

Igarashi

et al. 2017

The Journal of Dermatology

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“…However, the I 2 statistic8 of placebo effects (which describes the percentage of variance that is related to between‐study differences) was estimated to be 82%, suggesting that the parameterization for study‐specific placebo effect in the landmark model may have helped to adequately control for any potential study‐related heterogeneity in the dataset. A similar approach (estimating study‐specific placebo effects) was also attempted in the longitudinal model, but the results were inconclusive due to overparameterization.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluations of Time‐Course and Treatment Effects of Systemic Agents for Psoriasis: A Model‐Based Meta‐Analysis

Checchio

Ahadieh

Gupta

et al. 2017

Clin Pharma and Therapeutics

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Aggregate data model‐based meta‐analysis is a regression approach to compare the dose–response and/or time‐course across different treatments using summary level data from the literature. Literature search and systematic review following the Cochrane approach yielded 912 sources for investigational and approved treatments for psoriasis. In addition, data for tofacitinib were obtained from an internal database. Tofacitinib is an oral Janus kinase inhibitor. Two mathematical models were developed for Psoriasis Area and Severity Index (PASI) response in moderate to severe psoriasis patients to quantify the time to maximum effect for PASI75 and to evaluate the dose–response relationship for PASI responders (PASI50, PASI75, PASI90, PASI100) at Week 12. Body weight exhibited an inverse effect on the placebo component of both models, suggesting that body weight affects the overall PASI response regardless of drug. This analysis provides a quantitative framework for efficacy comparisons across psoriasis treatments.

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“…Long‐term (e.g., >10 years) methotrexate therapy can be effective for many patients with moderate‐to‐severe psoriasis 18; however, only an estimated 50–60% of patients who tolerate oral methotrexate doses of 15–20 mg/week will achieve marked improvement, leaving 40–50% of patients without an effective therapy 27. In addition, side effects of methotrexate are common, and regular safety monitoring is required 18.…”

Section: Considerations For Switching Therapymentioning

confidence: 99%

“…In addition, side effects of methotrexate are common, and regular safety monitoring is required 18. Up to 30% of patients discontinue methotrexate treatment due to adverse events including gastrointestinal intolerability, hepatotoxicity, bone marrow suppression, acute pneumonitis, and pulmonary fibrosis 27. Risk factors that can result in hepatotoxicity are coexisting hepatitis B or C, alcohol consumption, obesity, and type 2 diabetes mellitus.…”

Section: Considerations For Switching Therapymentioning

confidence: 99%

“…Risk factors that can result in hepatotoxicity are coexisting hepatitis B or C, alcohol consumption, obesity, and type 2 diabetes mellitus. To reduce the potential for liver toxicity, the American Academy of Dermatology Guidelines suggest switching to a different therapy (or performing liver biopsy) once patients reach a cumulative methotrexate exposure of 3.5–4.0 g 27. Patients should be carefully screened for comorbidities before initiating treatment and methotrexate should be avoided in high‐risk patients 28.…”

Section: Considerations For Switching Therapymentioning

confidence: 99%

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An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

Kerdel

Zaiac

2015

Dermatologic Therapy

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Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients’ cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end‐organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near‐complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate‐to‐severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients’ psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patient's clinical needs and treatment preferences.

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Guidelines of care for the management of psoriasis and psoriatic arthritis

Cited by 395 publications

References 193 publications

Secukinumab improves psoriasis symptoms in patients with inadequate response to cyclosporine A: A prospective study to evaluate direct switch

Secukinumab improves psoriasis symptoms in patients with inadequate response to cyclosporine A: A prospective study to evaluate direct switch

Quantitative Evaluations of Time‐Course and Treatment Effects of Systemic Agents for Psoriasis: A Model‐Based Meta‐Analysis

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

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