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. 2022 Dec;61(12):1543-1551.
doi: 10.1111/ijd.16192. Epub 2022 May 24.

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach

Clara De Simone  1 , Paolo Dapavo  2 , Piergiorgio Malagoli  3 , Alessandro Martella  4 , Anna Campanati  5 , Elena Campione  6 , Enzo Errichetti  7 , Chiara Franchi  8 , Alessio Gambardella  9 , Matteo Megna  10 , Federica Osti  4 , Simone Ribero  11 , Giovanni Zagni  12 , Piergiacomo Calzavara-Pinton  13 , Gabriella Fabbrocini  7 ; PAM Italian Working Group; Giuseppe Fabrizio Amoruso, Francesco Baglieri, Anna Silvia Biamonte, Tommaso Bianchelli, Laura Bigi, Jarno Bortoli, Bruno Brunetti, Cinzia Buligan, Elisabetta Cagni, Ombretta Calderoni, Piergiacomo Calzavara-Pinton, Anna Campanati, Alighiero Caputo, Carlo Giovanni Carrera, Andrea Carugno, Karin Chersi, Stefano Cicchelli, Flora De Natale, Clara De Simone, Paolo Dapavo, Domenico Di Maria, Enzo Errichetti, Gabriella Fabbrocini, Angelo Salvatore Ferrari, Emanuela Fogli, Riccardo Forconi, Chiara Franchi, Augusto Galeazzi, Alessio Gambardella, Andrea Giovannini, Maria Teresa Giura, Massimo Iuculano, Giuseppe Lazzaretti, Claudia Leporati, Massimiliano Magnanini, Piergiorgio Malagoli, Barbara Marconi, Alessandro Martella, Adriana Maruccia, Matteo Megna, Roberta Miglietta, Anna Minuti, Luigi Mocci, Sonia Modica, Alessandra Narcisi, Giulia Odorici, Federica Osti, Massimiliano Pazzaglia, Rossana Peila, Ginevra Pertusi, Michele Pezza, Elio Pezzullo, Nunzio Puccia, Umberto Raulo, Simone Ribero, Mariateresa Rossi, Sergio Rusignuolo, Giada Sapienza, Catello Savarese, Mariaelena Scalisi, Davide Strippoli, Elena Stroppiana, Rossana Tiberio, Antonino Trischitta, Maria Giovanna Tucci, Fabrizio Vaira, Anna Verrone, Lucia Villa, Fabio Zagni, Andrea Zoccali
Affiliations

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach

Clara De Simone et al. Int J Dermatol. 2022 Dec.

Abstract

Background: Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis.

Methods: A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process.

Results: Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation.

Conclusions: The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

Keywords: Cal/BD; adherence; consensus; long-term; proactive management; psoriasis.

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Figures

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Figure 1
The overall structure of the ProActive Management project Source: Original—no permissions required
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