A few highlights of the biologics, systemic non-biological, and topical therapies treatment guidelines include:
- Discusses the use of topical corticosteroids for longer than 12 weeks as well as the alternate use of steroids and steroid-sparing agents for the management of chronic disease
- Revised monitoring guidance to methotrexate associated hepatoxicity, which now recommends new non-invasive tests to evaluate for hepatic fibrosis
- Oral apremilast is recommended for the treatment of moderate to severe psoriasis in adults
- Discusses the dermatologist’s role in monitoring patients and educating them about the risks and benefits associated with the use of biologic agents
Additionally, the Guidelines of Care for the Management and Treatment of Psoriasis with Biologics have been updated to include 11 biologic treatments available at the time of publication, an update from 3 approved when the previous guidelines were published. These guidelines are also based on an increased amount of published research specifically related to psoriasis, where prior guidelines used the more comprehensive research available, which also included research related to psoriatic arthritis and other conditions.
More than just providing updated information and recommendations to providers, these new guidelines assist in justifying patient access to new treatments. “There have been so many advances in the treatment of psoriasis since the last guidelines were published in 2008, that there was a clear need to signal insurers that new treatments were available and patients needed to get access to those new therapies. NPF and the AAD have jointly issued these guidelines which justify patient access to the many new treatments available,” says Dr. Mark Lebwohl, M.D., Waldman Chair of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City and chairman emeritus of the NPF Medical Board.
Phototherapy is recognized as an effective treatment option for many patients and can include options such as narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, and targeted UVB treatments. While there were guidelines published in 2009 related to phototherapy, these new guidelines are an important update. “There has been so much progress in psoriasis in the last decade that this update was long overdue. The most important change is that we completely reworked the standard narrowband phototherapy dosing protocol. The new dosing in the guidelines was tested in the Vascular Inflammation in Psoriasis trial and demonstrated efficacy comparable to adalimumab both in terms of objective response (PASI75) and improvement in patient-reported quality of life. In fact, patients randomized to phototherapy tended to do better on patient-reported outcomes compared to adalimumab,” says Dr. Joel Gelfand, M.D., Professor of Dermatology and Epidemiology at the University of Pennsylvania Perelman School of Medicine.
Highlights from the Guidelines of Care for the Management and Treatment of Psoriasis with Phototherapy:
- Recommended dosing regimen, efficacy, and adverse effects of the various phototherapy modalities
- Discusses evidence-based use of phototherapy in different types of psoriasis and in combination with other treatment modalities
- Shares safety data such as adverse events and contraindications
“Phototherapy is highly effective and safe for the treatment of psoriasis. However, it is not backed by a major pharmaceutical company, and therefore there is virtually no direct to consumer advertising to build awareness,” adds Dr. Gelfand.
Even though research has shown that comorbidities commonly occur in patients with psoriasis, the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities are the first from the American Academy of Dermatology to address comorbidities in this patient group. “Comorbidities are extremely common in patients with psoriasis. The most common ones are psoriatic arthritis, high blood pressure, diabetes, obesity and cardiovascular disease,” shares Dr. Gelfand. “Some of our therapies are particularly helpful for psoriatic arthritis, while others may induce or aggravate co-morbidities such as inflammatory bowel disease, depression or multiple sclerosis. It is critical that the provider has a complete understanding of the patient’s underlying health issues.”