A consensus report on appropriate treatment optimization and transitioning in the management of moderate‐to‐severe plaque psoriasis. (26th February 2013)

• Record Type: Journal Article
• Authors: Mrowietz, U.; de Jong, E.M.G.J.; Kragballe, K.; Langley, R.; Nast, A.; Puig, L.; Reich, K.; Schmitt, J.; Warren, R.B.
• Is Part Of: Journal of the European Academy of Dermatology and Venereology. Volume 28:Number 4(2014:Apr.)
• Page Start: 438
• Page End: 453
• Publication Date: 2013-02-26
• Subjects: Dermatology -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.5
• DOI: 10.1111/jdv.12118
• Languages: English
• ISSNs: 0926-9959

Abstract

<abstract abstract-type="main" xml:lang="en" id="jdv12118-abs-0001"> <title>Abstract</title> <sec id="jdv12118-sec-0001" sec-type="section"> <title>Background</title> <p>There is limited information on systemic and biological treatment optimization and transitioning in routine clinical practice.</p> </sec> <sec id="jdv12118-sec-0002" sec-type="section"> <title>Objective</title> <p>To provide practical guidance on treatment optimization and transitioning for moderate‐to‐severe plaque psoriasis.</p> </sec> <sec id="jdv12118-sec-0003" sec-type="section"> <title>Methods</title> <p>Dermatologists from 33 countries contributed to the Transitioning Therapies programme. Fourteen questions were identified. Answers were drafted based on systematic literature reviews (7/14 questions) and expert opinion (7/14 questions). Using a modified Delphi procedure, dermatologists from 30 countries voted on their level of agreement with each draft answer (scale: 1–9, strong disagreement to strong agreement). Consensus was defined as ≥75% of participants scoring within the 7–9 range.</p> </sec> <sec id="jdv12118-sec-0004" sec-type="section"> <title>Results</title> <p>Consensus was achieved on the answers to all questions. Recommendations for the use of cyclosporine and methotrexate were agreed. Transitioning from a conventional systemic therapy to a biological agent may be done directly or with an overlap (if transitioning is required because of lack of efficacy) or potentially with a treatment‐free interval (if transitioning is required for safety reasons). Combination therapy may be beneficial. Continuous therapy for patients on biologicals is strongly recommended. However, during successful maintenance with biological monotherapy, a dosage reduction may be considered to limit drug exposure, although this may carry the risk of decreased efficacy. Switching biologicals for reasons of efficacy should be done without a washout period, but switching for reasons of safety may require a treatment‐free interval.</p> </sec> <sec id="jdv12118-sec-0005" sec-type="section"> <title>Conclusion</title> <p>This consensus provides practical guidance on treatment optimization and transitioning for moderate‐to‐severe plaque psoriasis, based on literature reviews and the expert opinion of dermatologists from across the globe.</p> </sec> </abstract>