What is the optimal treatment for psoriasis?

From the Guidelines

The best treatment for psoriasis is a stepwise approach, starting with topical treatments for mild to moderate cases, and progressing to phototherapy, systemic medications, and biologic therapies for more severe or resistant cases, as supported by the most recent guidelines 1.

Treatment Approach

The treatment of psoriasis depends on the severity and type of psoriasis a person has. For mild to moderate psoriasis, topical treatments are usually the first line of therapy, including:

• Corticosteroids (such as betamethasone or clobetasol)
• Vitamin D analogues (calcipotriene)
• Retinoids (tazarotene)
• Calcineurin inhibitors (tacrolimus) These are applied directly to affected skin areas once or twice daily until improvement occurs.

Phototherapy and Systemic Medications

For moderate to severe psoriasis, phototherapy using UVB light or PUVA (psoralen plus UVA) may be recommended, typically administered 2-3 times weekly for several months. When these treatments are insufficient, systemic medications become necessary, including oral options like:

• Methotrexate (starting at 7.5-15mg weekly)
• Cyclosporine (2.5-5mg/kg/day)
• Acitretin (25-50mg daily)

Biologic Therapies

For severe or resistant cases, biologic therapies targeting specific immune pathways are highly effective, including:

• TNF inhibitors (adalimumab, etanercept)
• IL-17 inhibitors (secukinumab, ixekizumab)
• IL-23 inhibitors (guselkumab, risankizumab)
• IL-12/23 inhibitors (ustekinumab) These biologics are typically administered by injection every 1-12 weeks depending on the specific medication, as outlined in the guidelines 1.

Lifestyle Modifications

Lifestyle modifications including maintaining a healthy weight, reducing stress, avoiding alcohol, and moisturizing regularly can complement medical treatments, as noted in the guidelines 1.

Key Considerations

The choice of treatment should be tailored to the individual patient's needs, taking into account the severity of the disease, patient preferences, and potential side effects, as emphasized in the guidelines 1.

From the FDA Drug Label

HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: Plaque Psoriasis (Ps) (1. 7): 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. Plaque Psoriasis or Adult Uveitis (2.5): Adults: 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.

The best form of treatment for psoriasis, according to the label, is systemic therapy or phototherapy. Adalimumab (HUMIRA) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. The recommended dosage for plaque psoriasis is an 80 mg initial dose, followed by 40 mg every other week starting one week after the initial dose 2.

• Key points:
  • Indicated for moderate to severe chronic plaque psoriasis
  • Systemic therapy or phototherapy are treatment options
  • Adalimumab (HUMIRA) is a TNF blocker
  • Recommended dosage: 80 mg initial dose, followed by 40 mg every other week
• Important considerations:
  • Patients should be candidates for systemic therapy or phototherapy
  • Other systemic therapies should be medically less appropriate
  • Monitor for serious infections and malignancies 2

From the Research

Treatment Options for Psoriasis

• Topical therapies are the mainstay for patients with limited or mild psoriasis, with topical vitamin D analogs and corticosteroids being the most widely prescribed psoriasis drugs 3.
• Combination therapies, such as combining topical agents with biologics, conventional systemic agents, and phototherapy, have been shown to provide clinical benefits 3, 4, 5.
• The use of combinations of vitamin D derivatives and corticosteroids as topical combinations is well supported in the literature 4, 5, 6.
• Phototherapy and topical vitamin D derivatives, as well as phototherapy in combination with oral retinoids, are also well supported in the literature 4, 5.

Combination Therapy

• Combination treatments consisting of vitamin D derivative and corticosteroid, vitamin D derivative and UV-B, and other combinations have been shown to be more effective than monotherapies 5.
• Combinations of preparations with different pharmacologic modes of action are often superior to monotherapy 6.
• Combination therapy plays an important role in daily practice, with various combinations of topical, UV-light, and systemic therapies being used 7.

Efficacy and Safety

• The efficacy and safety of combination therapy in psoriasis have been evaluated in several studies, with results showing that combination therapies can be effective in achieving disease clearance 4, 5.
• However, large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis are limited 4.
• The use of combination treatments requires a benefit-risk assessment, with data on this being more sparse in medical literature compared to monotherapies 7.