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Algorithm to select optimal systemic anti‐psoriatic drugs in relation with patients' Psoriasis Area and Severity Index score for plaque psoriasis
Author(s) -
Bae Soo Hyeon,
Yun Sook Jung,
Lee JeeBum,
Kim SeongJin,
Won Young Ho,
Lee SeungChul
Publication year - 2016
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/1346-8138.13195
Subject(s) - psoriasis area and severity index , medicine , psoriasis , acitretin , methotrexate , plaque psoriasis , gastroenterology , severity of illness , dermatology
This study sought to develop a therapeutic algorithm for selecting the optimal systemic drugs to treat moderate to severe psoriasis, based on the patient's Psoriasis Area Severity Index ( PASI ) score. Data from 191 patients undergoing treatment for plaque psoriasis were retrospectively analyzed. Pre‐ and post‐treatment PASI scores were compared across patients treated with acitretin of retinoic acid ( RA ; n = 95), methotrexate ( MTX ; n = 41) or cyclosporin A (CsA; n = 55). The PASI score improvement was examined at weeks 4 (primary end‐point) and 12 (secondary end‐point). MTX and CsA had a higher global therapeutic efficacy, with more patients exhibiting a marked improvement (≥75% improvement in PASI [ PASI 75]) at week 12 with MTX (56.1%, P = 0.028) and CsA (54.5%, P = 0.025) than RA (35.8%). Multivariate analysis adjusting for confounders produced consistent results ( P = 0.026). For patients with severe psoriasis ( PASI >12), the PASI 75 response was higher with CsA (55.6%) than RA (31.5%) ( P = 0.023) at week 4 and higher with MTX (57.1%, P = 0.029) and CsA (61.5%, P = 0.017) than RA (21.7%) at week 12. Because RA is a standard systemic drug, the RA group was divided into two subgroups based on the PASI 50 response at week 12. Marked or moderate improvement ( PASI ≥50) with RA was observed in patients with a pretreatment PASI score less than 14. Thus, oral RA is recommended as a first‐line drug for patients with PASI of less than 14, and MTX or CsA are recommended for patients with PASI of 14 or more.