From the Guidelines
Plaque psoriasis treatment should start with topical therapies, and for moderate to severe cases, biologics such as adalimumab or etanercept are recommended as first-line treatment options. The treatment approach should be multi-tiered, considering the severity of the disease, affected body areas, patient preferences, and comorbidities.
Topical Therapies
- Topical corticosteroids like betamethasone dipropionate 0.05% or clobetasol propionate 0.05% can be applied once or twice daily to affected areas for 2-4 weeks 1.
- Vitamin D analogs such as calcipotriene 0.005% ointment can be used alone or in combination with steroids, applied twice daily 1.
- Moisturizers should be used regularly to reduce scaling and itching.
Biologics
- Adalimumab is recommended as a monotherapy treatment option for adult patients with moderate-to-severe plaque psoriasis, with a recommended starting dose of 80 mg taken as 2 self-administered subcutaneous 40-mg injections of the initial dose, followed by a 40-mg self-administered subcutaneous injection 1 week later, followed by 40 mg self-administered every 2 weeks thereafter 1.
- Etanercept is recommended as a monotherapy treatment option for adult patients with moderate-to-severe plaque psoriasis, with a recommended starting dose of 50 mg taken as a self-administered subcutaneous injection twice weekly for 12 consecutive weeks 1.
Phototherapy
- Phototherapy (UVB or PUVA) may be recommended for moderate to severe cases not responding to topicals, typically administered 2-3 times weekly for 8-12 weeks 1.
Systemic Medications
- For extensive disease, systemic medications like methotrexate (starting at 7.5-15mg weekly), cyclosporine (2.5-5mg/kg/day), or biologics such as adalimumab, etanercept, or ustekinumab may be necessary 1.
The most recent and highest quality study 1 provides recommendations for the combination of topical agents with biologics, which can be used to augment efficacy for the treatment of moderate to severe psoriasis.
It's essential to consider the potential risks and benefits of each treatment option and to tailor the treatment approach to the individual patient's needs and preferences.
From the FDA Drug Label
1.7 Plaque Psoriasis HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see Warnings and Precautions (5)].
Treatment of Psoriasis Plaque: Adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis.
- The recommended dosage for plaque psoriasis is not explicitly stated in the provided text, but the dosage for other conditions is provided.
- Key Considerations:
- HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.
- Patients should be candidates for systemic therapy or phototherapy, and other systemic therapies should be medically less appropriate. 2
From the Research
Psoriasis Plaque Treatment Options
- Topical corticosteroids, such as clobetasol propionate spray 0.05%, can be effective in treating moderate to severe plaque psoriasis, with 81.0% of participants with moderate disease and 79.5% of participants with severe disease achieving clear or almost clear skin 3
- Biologics, including tumor necrosis factor α (TNF-α) inhibitors, interleukin (IL)-12 and IL-23 inhibitors, and IL-17 inhibitors, are also effective in treating moderate to severe plaque psoriasis, with high efficacy and acceptable safety profiles 4, 5
- Topical corticosteroid therapy, including clobetasol propionate 0.025% cream, can be effective in treating plaque psoriasis, with the use of penetration enhancers potentially increasing potency 6
- Maintenance intermittent treatment with topical steroids can be useful in prolonging remission in patients with plaque psoriasis 7
Treatment Considerations
- The choice of treatment for psoriasis plaque depends on the severity of the disease, with topical agents being the mainstay of treatment for mild psoriasis and biologics being an option for first-line treatment of moderate to severe plaque psoriasis 4
- The use of biologics in the treatment of psoriasis plaque is associated with several unresolved issues, including the lack of extensive experience with these agents in patients with psoriasis 5
- Topical corticosteroids can have adverse effects, including erythema, peeling, dryness, and stinging, and the use of biologics can be costly 3, 5
Treatment Efficacy
- The efficacy of topical corticosteroids in treating plaque psoriasis can be highly variable, with 30-90% of patients experiencing more than 50% improvement in initial psoriasis severity 7
- Biologics have been shown to be highly effective in treating moderate to severe plaque psoriasis, with etanercept, adalimumab, and infliximab being highly effective in the treatment of moderate to severe plaque psoriasis 4, 5