New guidelines on biologics in psoriasis


By Mardi Chapman

22 Mar 2019

As the number of biologics available for the treatment of psoriasis increase, there will be more decisions to be made on which drugs to use initially and if and when to switch between agents, new guidelines say.

A substantial update of US recommendations for the management of psoriasis with biologics has said efficacy, safety data and disease severity or impact won’t be the only deciding factors.

Patient preferences around dosing schedules, costs and route of administration will also need to be considered.

The guidelines fell short of making specific recommendations for switching between biologics due to a lack of evidence.

The joint American Academy of Dermatology (AAD) and National Psoriasis Foundation (NPF) guidelines considered evidence published between the last edition in 2008 and the end of 2017.

It summarised the evidence on eleven biologics including the TNF inhibitors and agents targeting the interleukins IL-12, IL-17 and IL-23.

This included drugs such as tildrakizumab and guselkumab which were recently listed on the PBS in Australia.

The guidelines said the importance of patient education as part of shared decision-making could not be overemphasised.

“Patients should also be aware of the side effect profile of prescribed therapies and have input in the treatment plan,” the guidelines said.

“Although biologic agents have shown tremendous efficacy and safety in clinical trials, pharmacovigilance is fundamental, and dermatologists serve a key role in the potential prevention and detection of adverse events over time. Repetition of key concepts during follow-up visits reinforces patient knowledge over time.”

As well as the evidence and recommendations on each of the biologics, the guidelines included advice on biologics in the context of surgical procedures and discontinuation of biologics to allow for administration of live vaccines.

Research gaps were noted around long term-adverse events, impacts on future co-morbidities, paediatric treatment, pregnancy and lactation, and treatment combinations for many of the newer biologic agents.

Also published in the Journal of the American Academy of Dermatology are guidelines for the management psoriasis with special attention to co-morbidities including psoriatic arthritis, cardiovascular disease, the metabolic syndrome, mental health issues, and inflammatory bowel disease.

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