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Integrating Biologic Agents into Management of Moderate-to-Severe Psoriasis: A Consensus of the Canadian Psoriasis Expert Panel

  • Published:
Journal of Cutaneous Medicine and Surgery

Abstract

Background

Approximately 2% of people worldwide have psoriasis, with as many as 1 million people with psoriasis in Canada alone.1,2 The severity of psoriasis ranges from mild to severe. It can lead to substantial morbidity and psychological stress and have a profound negative impact on patient quality of life.3,4 Although available therapies reduce therapies reduce the extent and severity of the disease and improve quality of life,3 reports have indicated a patient preference for more aggressive therapy and a dissatisfaction with the effectiveness of current treatment options.5

Objective

A Canadian Expert Panel, comprising Canadian dermatologists, convened in Toronto on 27 February 2004 to reach a consensus on unmet needs of patients treated with current therapies and how to include the pending biologic agents in and improve the current treatment algorithm for moderate-to-severe psoriasis. Current treatment recommendations suggest a stepwise strategy starting with topical agents followed by phototherapy and then systemic agents.3,6,7 The Panel evaluated the appropriate positioning of the biologic agents, once approved by Health Canada, for the treatment of moderate-to-severe psoriasis.

Methods

The Panel reviewed available evidence and quality of these data on current therapies and from randomized, controlled clinical trials.8–14 Subsequently, consensus was achieved by small-group workshops followed by plenary discussion.

Results

The Panel determined that biologic agents are an important addition to therapies currently available for moderate-to-severe psoriasis and proposed an alternative treatment algorithm to the current step wise paradigm.

Conclusion

The Panel recommended a new treatment algorithm for moderate-to-severe psoriasis whereby all appropriate treatment options, including biologic agents, are considered together and patients’ specific characteristics and needs are taken into account when selecting the most appropriate treatment option.

Sommaire

Antècèdents

Près de 2 % de la population mondiale est atteinte de psoriasis, dont un million de personnes au Canada.1,2 Le psoriasis peut varier de bénin à grave. Cette affection entraîne arfois une morbidité accrue et une détresse psychologique en plus d’avoir un impact négatif profond’sur la qualité de vie du patient.3,4 Bien que les traitements disponibles réduisent I’étendue et la gravité de la maladie et améliorent la qualité de vie,3 les rapports ont dénoté une préférence pour les traitements plus agressifs et une insatisfaction à I’égard de I’efficacite des options de traitement actuelles.5

Objectif

Un panel d’experts canadiens, formé de dermatologues, s’est réuni á Toronto le 27 février 2004 en vue d’atteindre un consensus sur les besoins non comblés des patients traités au moyen des thérapies actuelles, ainsi que d’évaluer les façons d’inclure les agents biologiques et d’améliorer les algorithmes de traitement du psoriasis modéré à grave. Actuellement, les traitements recommandés sont axés sur une stratégic par étapes, débutant avec des agents topiques, suivis d’une phototherapie et enfin des agents systémiques.3,6,7 panel a évalué le positionnement approprié des agents biologiques, une fois approuvés par Santé Canada, dans le traitement du psoriasis modéré à grave.

Méthodes

Le panel a passé en revue les rapports disponibles et la qualite des données relativement à ces thérapies ainsi que ceux des essais cliniques randomisés.8–14 Par la suite, un consensus a été atteint au moyen de petits ateliers de travail suivis d’une discussion plénière.

Résultats

Le panel a déterminé que les agents biologiques étaient un important ajout aux options thérapeutiques offertes actuellement dans le traitement du psoriasis modéré à grave et a proposé un algorithme de traitement en replacement à I’algorithme par étapes actuel.

Conclusion

Le panel a recommandé un nouvel algorithme de traitement pour le psoriasis modéré à grave, où on considère toutes les options thérapeutiques, y compris les agents biologiques, dans leur ensemble et on tient compte des caractéristiques et des besoins specifiques de chaque patient dans le choix de I’option adéquate.

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Author information

Authors and Affiliations

  1. Department of Dermatology, University of Western Ontario, London, Ontario, Canada

    Lyn Guenther

  2. The Guenther Dermatology Research Centre, 835 Richmond Street, London, Ontario, N6A 3H7, Canada

    Lyn Guenther

  3. Division of Dermatogy, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada

    Richard G. Langley

  4. Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Science Centre, University of Toronto Medical School, Toronto, Ontario, Canada

    Neil H. Shear

  5. Ventana Clinical Research Corporation, Toronto, Ontario, Canada

    Neil H. Shear

  6. Innovaderm Research Inc., Montreal, Quebec, Canada

    Robert Bissonnette

  7. Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada

    Vincent Ho

  8. University Health Network, University of Toronto, Toronto, Ontario, Canada

    Charles Lynde

  9. Lynde Centre for Dermatology, Markham, Ontario, Canada

    Charles Lynde

  10. Department of Dermatology, University of Manitoba, Winnipeg, Manitoba, Canada

    Eileen Murray

  11. Winnipeg Clinic, Winnipeg, Manitoba, Canada

    Eileen Murray

  12. Probity Medical Research, Waterloo, Ontario, Canada

    Kim Papp

  13. Department of Dermatology, Laval University, Sainte Foy, Quebec, Canada

    Yves Poulin

  14. Centre Dermatologique, Sainte Foy, Quebec, Canada

    Yves Poulin

  15. Department of Dermatology, University of Calgary, Calgary, Alberta, Canada

    Catherine Zip

  16. The Dermatology Centre, Calgary, Alberta, Canada

    Catherine Zip

Authors
  1. Lyn Guenther
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  2. Richard G. Langley
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  3. Neil H. Shear
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  4. Robert Bissonnette
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  5. Vincent Ho
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  6. Charles Lynde
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  7. Eileen Murray
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  8. Kim Papp
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  9. Yves Poulin
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  10. Catherine Zip
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Corresponding author

Correspondence to Lyn Guenther.

Additional information

The Canadian Expert Panel meeting was supported by an educational grant from Serono Canada Inc. The opinions expressed are those of the authors and not of Serono. All participants have been involved in clinical trials involving at least one of the therapeutic agents discussed.

At the time of the Canadian Expert Panel meeting, biologic agents such as alefacept, efalizumab, etanercept, and infliximab were not approved in Canada for the treatment of psoriasis. Upon final submission of this article, alefacept had just received approval for the treatment of psoriasis.

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Guenther, L., Langley, R.G., Shear, N.H. et al. Integrating Biologic Agents into Management of Moderate-to-Severe Psoriasis: A Consensus of the Canadian Psoriasis Expert Panel. J Cutan Med Surg 8, 321–337 (2004). https://doi.org/10.1007/s10227-005-0035-1

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  • DOI: https://doi.org/10.1007/s10227-005-0035-1

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