Methotrexate in the therapeutic pathway of patients with psoriasis. Analysis of clinical practice data and comparison with guidelines

Abstract

Introduction Psoriasis is an inflammatory skin disease with a chronic-relapsing course. It is estimated that the prevalence in Italy is 3%. An adequate model of taking care of the patient with psoriasis allows the patient to benefit from the most suitable treatment option for his health needs. In this position statement the observations, criticalities and proposals for improvement of the Pso-Path Working Group, composed by health economists, clinicians and patients, on the diagnostic-therapeutic pathway of the patient with psoriasis have been collected. In particular, the deviation of clinical practice from the current Guidelines for the management of patients with psoriasis, which recommend the use of biologic drugs in case of non-response, intolerance or contraindication to Methotrexate or Cyclosporine, was evaluated. Method A Working Group was convened whose participants were asked to express their thoughts on the diagnostic and therapeutic pathway of the patient with psoriasis, bringing out critical elements and proposals for improvement, based on their experiences. Conclusion This position statement summarizes the experiences and consensus between clinicians and patients on actions to optimize the management of patients with psoriasis undergoing biological treatment. Compared to the epidemiological data currently available, it is believed that only a small percentage of patients with psoriasis are treated with systemic drugs. The perception of clinicians, according to their experience, confirms the data emerging from the National Report "National Observatory on the Use of Medicines" (Osmed) compiled by AIFA in 2015, according to which more than 77% of patients with psoriasis are started to treatment with biological drugs without a previous use of Methotrexate or Cyclosporine for at least 3 months. The Pso-Path Working Group came to the conclusion that it would be desirable to incentivize, through the formalization of regional guidelines, the creation of a network system that promotes not only a greater awareness, at the territorial level, of the importance and impact of the disease and the possible paths, but also the collaboration and connection between all the actors involved in the overall care of the patient.

Portable Cold Atmospheric Plasma Patch‐Mediated Skin Anti‐Inflammatory Therapy

“…Instead, there are various therapeutic options for the treatment of psoriasis, such as topical agents (corticosteroids, vitamin D analogs, retinoids, calcineurin inhibitors, and coal tar), immunosuppressive agents (Methotrexate and Cyclosporine), and biologic agents (Etanercept, Adalimumab, Infliximab, and Ustekinumab). [ 76 , 77 , 78 ] However, the proven existing treatments are applied to both the lesional and non‐lesional areas; therefore, resulting in adverse effects on the latter. Here, we aimed to treat the lesion area exclusively.…”

Real-World Experience of Methotrexate in the Treatment of Skin Diseases: an Italian Delphi Consensus

“…The latter allows improvement of patient compliance due to a better gastrointestinal tolerability and higher efficacy. To manage safety aspects appropriately, it is essential to evaluate the patient’s risk factors and carry out proper monitoring during the course of treatment [ 84 ].…”

Cost per responder for methotrexate versus other therapies in patients with moderate-to-severe plaque psoriasis in Italy

“…Nonostante la presenza di Linee Guida, il MTX risulterebbe essere sottoutilizzato come dimostrato dallo studio di real world di Clicon et al, riportato in Corazza et al ( 13 ), in cui dei 495 pazienti inclusi con psoriasi e in trattamento con farmaci biologici solo il 43,2% (N = 214) era stato trattato con metotrexato o ciclosporina nell’anno precedente l’inizio della terapia biologica e di questi il 52,3% (N = 112) aveva ricevuto un trattamento convenzionale per un periodo di almeno 3 mesi. Considerando l’intera popolazione inclusa (N = 495), solo il 22,6% dei pazienti aveva ricevuto una terapia con metotrexato o ciclosporina per almeno 3 mesi nell’anno prima del trattamento biologico.…”