New psoriasis guidelines emphasize management of comorbidities, use of biologics
The guidelines cautioned that there is still limited evidence about long-term adverse events, impacts on future comorbidities, pediatric treatment, pregnancy and lactation, treatment combinations for newer biologics, and a need to identify biomarkers.
Two new evidence-based guidelines outline best practices for management of psoriasis with a focus on comorbidities, as well as biologic treatment for the disease.
The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) issued the new guidelines of care for psoriasis in the Journal of the American Academy of Dermatology on Feb. 13.
“Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities” focuses on the other health conditions that may be associated with the disease, including psoriatic arthritis, cardiovascular disease, metabolic syndrome, and inflammatory bowel disease. The guidelines also address the increased risk of anxiety and depression in psoriasis patients, as well as the effects of smoking and alcohol consumption.
A multispecialty work group performed a comprehensive literature review and graded evidence using a three-point scale based on the quality of methodology and the overall focus of the study, with recommendations classified as follows:
A. Based on consistent and good-quality patient-oriented evidence;
B. Based on inconsistent or limited-quality patient-oriented evidence; and
C. Based on consensus, opinion, case studies, or disease-oriented evidence.
Among the many recommendations are the following:
- Patients with psoriasis should be informed about the association between psoriasis and psoriatic arthritis (B recommendation), and psoriatic arthritis should be considered in all patients with cutaneous psoriasis (B recommendation).
- Cardiovascular risk assessment (screening for hypertension, diabetes, and hyperlipidemia) according to national guidelines is recommended for all patients with psoriasis (B recommendation), and clinicians should consider early and more frequent screening for hypertension, diabetes, and hyperlipidemia in psoriasis patients who are candidates for systemic or phototherapy or who have psoriasis involving more than 10% of their body surface area (B recommendation).
- Patients with psoriasis should be informed about the association of psoriasis and anxiety and depression (B recommendation), and patients with psoriasis should be asked about signs and symptoms of anxiety and depression by their dermatologist or primary care clinician (B recommendation).
“Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Biologics” provides an overview of the biologic medications available for the treatment of moderate to severe psoriasis. In addition to outlining the research on the drugs' effectiveness and recommended starting and maintenance doses, the guidelines describe the potential adverse effects of each biologic.
“The advent of new medications with unique mechanisms of action affords significant opportunities for better disease control with minimal toxicity,” the guidelines stated. “Nevertheless, there is still limited evidence regarding long term-adverse events, impacts on future comorbidities, pediatric treatment, pregnancy and lactation, and treatment combination for many of the newer biologic agents. There is also an important need to identify biomarkers that can potentially predict the appropriate biologic agent for individual patients.”