French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults

Abstract

These guidelines were developed by the psoriasis research group of the French Society of Dermatology with the aim of providing updated decision-making algorithms for the systemic treatment of adult patients with moderate-to-severe psoriasis. Our algorithms were generated after rigorous evaluation of existing guidelines on the treatment of psoriasis and of publications concerning new systemic treatments, not yet incorporated into existing guidelines. A total of nine existing guidelines and 53 publications related to new systemic treatments were found to meet our criteria for use in the generation of the algorithms. We have proposed two new algorithms to assess therapeutic responses, both of which incorporate emerging criteria for evaluating treatment goals. Updated therapeutic strategy algorithms, incorporating both established and new systemic therapies, were also generated for the treatment of plaque psoriasis and psoriatic arthritis, together with recommendations for the treatment of particular forms of psoriasis and treatment of patients with comorbidities.

Figure 1

Treatment goals in plaque psoriasis. (a, b) Updated decision algorithms considered as acceptable by the current working group. DLQI, dermatology life quality index; PASI, psoriasis area severity index; PGA, physician global assessment.

Figure 2

Treatment algorithm for patients suffering from plaque psoriasis without comorbidities. CSA, cyclosporin; MTX, methotrexate; NBUVB, Narrowband UVB; PUVA, psoralen UVA; re‐PUVA, retinoid psoralen UVA.

Figure 3

Psoriatic arthritis treatment algorithm – adapted from the EULAR, GRAPPA and UK NICE guidelines.6, 9, 19, 20 APR, apremilast; ADA, adalimumab; CSA, cyclosporin; DMARD, disease‐modifying anti‐rheumatic drugs; MTX, methotrexate; NSAIDs, nonsteroidal anti‐inflammatory drugs; PsA, psoriatic arthritis; TNFi, tumour necrosis factor inhibitors; USTK, ustekinumab.