K. Kragballe

Definition of treatment goals for moderate to severe psoriasis: a European consensus

Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSAxa0>xa010 or PASIxa0>xa010) and DLQIxa0>xa010. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.

Biological therapies in the systemic management of psoriasis: International Consensus Conference

Psoriasis is a chronic, immune‐mediated disorder that usually requires long‐term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long‐term management of psoriasis can be complicated by treatment‐related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis.

There is limited information on systemic and biological treatment optimization and transitioning in routine clinical practice.

Improvements in patient-reported outcomes in moderate-to-severe psoriasis patients receiving continuous or paused etanercept treatment over 54 weeks: the CRYSTEL study.

Objectiveu2002 To assess patient‐reported outcomes (PRO) in patients with moderate‐to‐severe plaque psoriasis receiving continuous or paused etanercept treatment.

Scalp psoriasis: a review of current topical treatment options

The scalp is the most common site of disease involvement at the onset and throughout the course of psoriasis. For many patients, psoriasis of the scalp is the most difficult aspect of their disease; yet, despite a wide range of therapy options and an extensive literature base, scalp psoriasis remains difficult to treat, highlighting a long‐standing unmet need for the effective treatment of scalp psoriasis. A review of past and current medical literature reveals that a number of interesting therapeutic approaches have been used in the treatment of scalp psoriasis. The diverse and sometimes extreme therapeutic approaches, the marginal benefit of many topical agents, the paucity of controlled studies evaluating the efficacy of topical agents in the treatment of scalp psoriasis and the high level of patient dissatisfaction with currently available treatments for psoriasis all support the need for new, effective and well‐tolerated treatment options for scalp psoriasis.

Psoriasis: consensus on topical therapies.

Objectiveu2002 A consensus conference was convened to evaluate the topical treatment of psoriasis.

One‐year safety and efficacy of ustekinumab and results of dose adjustment after switching from inadequate methotrexate treatment: the TRANSIT randomized trial in moderate‐to‐severe plaque psoriasis

There are limited long‐term, ‘real‐world’ data on ustekinumab, or the effect of dose adjustment in suboptimal responders.

Remission and relapse of chronic plaque psoriasis treated once a week with clobetasol propionate occluded with a hydrocolloid dressing versus twice daily treatment with clobetasol propionate alone.

BACKGROUND: Many studies have shown the clinical efficiency of occlusion therapy for psoriasis, particularly corticosteroids used under hydrocolloid dressings. However, there are no data from comparative clinical studies evaluating the remission and relapse characteristics of such occlusion therapy compared with orthodox topical steroid monotherapy. METHODS: In a randomised, open-label, parallel group study from three centres, the remission and relapse characteristics were investigated for the use of a hydrocolloid dressing (HCD) over clobetasol propionate 0.05% lotion once a week compared with the same steroid in ointment formulation used unoccluded twice a day in 61 patients with stable chronic plaque psoriasis. RESULTS: There was a pronounced treatment difference in favour of the HCD + clobetasol propionate lotion group with respect to time to clearance, but there was little evidence for a difference with respect to time to relapse. CONCLUSION: The combination of the HCD + clobetasol propionate lotion provides a fast and highly effective remission induction.BACKGROUNDnMany studies have shown the clinical efficiency of occlusion therapy for psoriasis, particularly corticosteroids used under hydrocolloid dressings. However, there are no data from comparative clinical studies evaluating the remission and relapse characteristics of such occlusion therapy compared with orthodox topical steroid monotherapy.nnnMETHODSnIn a randomised, open-label, parallel group study from three centres, the remission and relapse characteristics were investigated for the use of a hydrocolloid dressing (HCD) over clobetasol propionate 0.05% lotion once a week compared with the same steroid in ointment formulation used unoccluded twice a day in 61 patients with stable chronic plaque psoriasis.nnnRESULTSnThere was a pronounced treatment difference in favour of the HCD + clobetasol propionate lotion group with respect to time to clearance, but there was little evidence for a difference with respect to time to relapse.nnnCONCLUSIONnThe combination of the HCD + clobetasol propionate lotion provides a fast and highly effective remission induction.

Transition to ustekinumab in patients with moderate‐to‐severe psoriasis and inadequate response to methotrexate: a randomized clinical trial (TRANSIT)

Limited data exist on transitioning patients with psoriasis from conventional systemic agents to biologics.

Long-term management of scalp psoriasis: perspectives from the international psoriasis council

The scalp is a well-known predilection site for psoriasis. Epidemiological data on the various manifestations of scalp psoriasis as well as on its therapeutic management are sparse. The understanding of the natural course of scalp psoriasis is relevant for its therapeutic management. In over 25% of patients, scalp psoriasis is the first signal of the psoriatic condition. Nevertheless, few of the therapies currently used for the treatment of scalp psoriasis have been evaluated for efficacy in the setting of well-designed, well-controlled clinical studies. The lack of comparative data impedes the interpretation of the results from studies of scalp psoriasis. Long-term studies of the efficacy and safety of scalp treatments are lacking. Moreover, clinical studies generally do not incorporate quality of life impact or mechanisms to enhance adherence thus hindering the optimal management of the patient over the long-term. Consequently, this report will evaluate the available data and the associated factors to be considered in the development of a treatment paradigm for the long-term management of the scalp psoriasis patient.