Patient-Centered Approach to Biologics in the Treatment of Psoriasis

Toral Vaidya, Steven R. Feldman, Julienne Kirk

Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

Background: With a growing number of psoriasis treatments options, making a decision can be daunting to patients. Biologics offer a less toxic and more effective alternative to people who have moderate-to-severe psoriasis, particularly those who have tried and failed other therapies.

Objective: To provide a patient-centered approach to the decision to start on biologic treatment of psoriasis with an overview of pharmacology.

Methods: An electronic literature search was performed in the PubMed and Medline databases using keywords with "biologics" or "biologic therapy,” “treatment,” and “safety.” Pharmaceutical package inserts and reference lists were also reviewed.

Results: Though new advancements in psoriasis care have improved treatment options for patients, widespread treatment dissatisfaction and under- treatment occurs. Biologic agents are generally well-tolerated and effective for managing moderate-to-severe psoriasis. Lifetime risks of serious adverse events from biologic treatment are less than risks patients face on a daily basis. Current data suggests biologics are not predictors of serious adverse events. Rates of major adverse cardiovascular event and death are lower in biologic cohorts compared to non-biologic cohorts. The minimal risk and potentially protective effects of biologics may outweigh the consequences of undertreated or non-treated moderate-to-severe psoriasis.

Limitations: Long-term data on biologic treatment safety is growing and this review will only encompass current data.

Conclusions: Treating psoriasis with biologics can reduce overall risk of bad outcomes of psoriasis and its treatment and improve patient quality of life. Optimizing treatment adherence, accommodating patient preferences, emphasizing strong patient-physician communication, and conceptualizing treatment risk can improve patient satisfaction and clinical outcomes. Successful psoriasis care is a long-term, collaborative, and complete commitment on behalf of both the patient and physician. Journal of Nature and Science, 1(3):e53, 2015.

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