• Open Access

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

Authors


  • Conflict of interest

      Conflict of interest
    • UM has been a consultant and/or speaker and/or participant in clinical trials and/or received grants from the following companies that manufacture drugs for the treatment of psoriasis including Abbott, Almirall-Hermal, BiogenIdec, Celgene, Centocor, Forward Pharma, Janssen, Leo Pharma, Medac, MSD Sharp & Dohme, Novartis, Pfizer. EdeJ has acted as consultant and/or paid speaker and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Janssen-Cilag, MSD and Pfizer. KK has declared no conflicts of interest. RL has served as a scientific advisory board advisor (SAB), investigator (I) or speaker (Sp) for Abbott (SAB, I, Sp), Amgen (SAB, I, Sp), Centocor (SAB, I), Pfizer (SAB, I) and Celgene (SAB, I). AN has received honoraria for CME certified educational talks that received indirect sponsorship from Abbott and Janssen-Cilag; the deBM (his employer) has received research grants from Wyeth (now Pfizer). LP has served as consultant and/or paid speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Celgene, Centocor, Janssen-Cilag, Leo, Merck, MSD (formerly Schering-Plough), Novartis, Pfizer (formerly Wyeth). KR has received honoraria as a consultant and/or advisory board member and/or acted as a paid speaker and/or participated in clinical trials sponsored by Abbott, Amgen, Biogen-Idec, Centocor, MSD (formerlyEssex Pharma, Schering Plough), UCB, Janseen-Cilag, Celgene, Pfizer (formerly Wyeth), Novartis, LEO Pharma, Basilea, Forward Pharma, Medac and Ocean Pharma. JS has acted as a paid speaker for Novartis and Abbott, and received research grants from Pfizer (formerly Wyeth) and from Novartis. RBW has acted a consultant and/or speaker for Abbott, Pfizer, Janssen, Leo and Schering Plough (now MSD).
  • Funding sources

      Funding sources
    • This study was funded through an educational grant to the Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany, from Abbott.

Abstract

Background

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

Objective

To provide practical guidance on treatment optimization and transitioning for moderate-to-severe plaque psoriasis.

Methods

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.

Results

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.

Conclusion

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.

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