What are the treatment options for psoriasis?

From the Guidelines

Psoriasis treatment should be approached with a multi-faceted strategy, prioritizing topical treatments for mild to moderate cases and reserving systemic medications, such as methotrexate or biologics like adalimumab, for more severe cases or when initial treatments fail, as recommended by the most recent guidelines 1.

Treatment Approach

When considering treatment options for psoriasis, it's essential to assess the severity of the disease and the patient's overall health. For mild to moderate psoriasis, topical treatments are the first line of defense, including:

• Corticosteroids like betamethasone valerate 0.1% applied twice daily to affected areas for 2-4 weeks
• Calcipotriene (a vitamin D analog) 0.005% ointment applied twice daily
• Combination products like Enstilar foam (calcipotriene/betamethasone) applied once daily

Systemic Medications

For more severe cases or when topical treatments are ineffective, systemic medications may be necessary, including:

• Methotrexate (starting at 7.5-15mg once weekly) 1
• Biologics like adalimumab (Humira, 40mg every other week) 1
• Secukinumab (Cosentyx, 300mg at weeks 0,1,2,3, and 4, then monthly)
• Oral options like apremilast (Otezla, titrated to 30mg twice daily)

Lifestyle Modifications

Regardless of treatment, patients should:

• Use gentle fragrance-free moisturizers daily
• Avoid triggers like stress and alcohol
• Maintain a healthy lifestyle These treatments work by targeting different aspects of the immune dysfunction that causes psoriasis, particularly the overactivation of T-cells and inflammatory cytokines that lead to the rapid skin cell turnover characteristic of the disease 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.

Psoriasis Treatment: 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 is an initial dose of 80 mg, 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
  • Initial dose: 80 mg
  • Maintenance dose: 40 mg every other week
  • Starting one week after the initial dose

From the Research

Psoriasis Treatment Options

• Topical therapies are the mainstay for the majority of patients who have limited or mild psoriasis, including topical vitamin D analogs and corticosteroids 3, 4, 5, 6
• For patients with more severe disease, phototherapy, conventional systemic agents, and biologics are often indicated 3, 7, 5
• Combination therapies are widely used by physicians, and adjunctive topical therapies used with other antipsoriatic regimens have been demonstrated to provide many clinical benefits 3, 4, 6

Topical Therapies

• Topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics are commonly used topical agents for psoriasis treatment 4, 5, 6
• The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis 5
• Topical therapies can be used as both monotherapy and adjunctive therapy, and their selection, effective combination therapies, duration of use, and adverse events should be carefully considered 6

Systemic and Phototherapy

• Phototherapy, conventional systemic agents, and biologics are often used to treat moderate to severe psoriasis 3, 7, 5
• Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are approved for the treatment of psoriatic arthritis and plaque psoriasis 5
• Oral treatments, such as methotrexate, acitretin, cyclosporine, and apremilast, can be used to treat psoriasis, but may have adverse effects 7, 5

Treatment Goals and Patient Adherence

• The goal of treatment is to control the clinical symptoms of the skin, reduce systemic disease potential, and improve the patient's quality of life 3, 7
• Patient adherence to medication is a key factor for a treatment to be effective, and addressing patient preferences and concerns can improve treatment outcomes 4, 6