Saudi consensus statement on biologic treatment of chronic plaque psoriasis (2020)

Abstract

Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million people worldwide. Management of psoriasis in daily clinical practice in Saudi Arabia is variable. Local preferences for management differ, which may have a bearing on the treatment selection. Biologic therapy is now a well-established strategy for managing moderate-to-severe plaque psoriasis. There is a clear need for national consensus statements due to the extended role and high availability of literature on these agents. As a result of an initiative of the Ministry of Health, a multidisciplinary expert panel of dermatologists and pharmacists with practical experience in the clinical management of psoriasis were invited to be part of a work group to update the previous practical guidelines on the biologic treatment of psoriasis published in the Journal of Dermatological Treatment, 2014. The overall aim of this consensus document is to deliver evidence-based recommendations on the use, screening, and monitoring of biologic therapy in patients with moderate-to-severe plaque psoriasis. These recommendations also address the use of biologic therapy in special patient populations. They were developed after rigorous evaluation of existing international guidelines as well as the latest emerging evidence. Updates of the present consensus document will be provided as needed to incorporate new data or agents.

Psoriasis in Northern Saudi Arabia: Clinical features and implications for quality of life

“…The incidence increases in late teens and 20s and again in 50s and 60s with slightly later ages in males than females. 16 – 18 In our study, this bimodality was not evident since patients under 45 years of age represented 75% of the study population with a higher proportion of female than male patients, which increased the frequency of early-onset psoriasis while the next psoriasis wave was absent. By agreement, 72.9% of patients enrolled in the Psoriasis Longitudinal Assessment and Registry (PSOLAR) had early-onset psoriasis.…”

“…Systemic treatment has been frequently consumed by psoriasis patients with more severe disease and longer duration while mild to moderate cases have been adequately treated with topical corticosteroids, vitamin D analogs, keratolytics, tar preparation, or phototherapy. 16 , 19 , 35 …”

“…29 Systemic treatment has been frequently consumed by psoriasis patients with more severe disease and longer duration while mild to moderate cases have been ade-quately treated with topical corticosteroids, vitamin D analogs, keratolytics, tar preparation, or phototherapy. 16,19,35 Psoriasis results from the interaction between immune, genetic, and environmental factors. A positive family history of psoriasis was found in 47.5% of patients with earlyonset psoriasis and 36.9% of those with late-onset psoriasis.…”

“…Second, the patient was asked to give an average score for his/her psoriasis lesions as 0 (clear or just slight redness of staining), 1 (mild redness or scaling with no more than slight thickening), 2 (definite redness, scaling, or thickening), 3 (moderately severe with obvious redness, scaling, or thickening), 4 (very red and inflamed, very scaly, or very thick), or 5 (intensely inflamed skin with or without pustules). The product of the first and second scores produced the sa-SPI-s index, which was then subdivided into mild (<10), moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or severe (>20) psoriasis.…”