Psoriasis: Which therapy for which patient : Focus on special populations and chronic infections - 13/12/18

Doi : 10.1016/j.jaad.2018.06.056

Shivani B. Kaushik, MD ^⁎ , Mark G. Lebwohl, MD
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York

^∗Correspondence to: Shivani Kaushik, MD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Box 1047, New York, NY 10029.Department of DermatologyIcahn School of Medicine at Mount Sinai1425 Madison Ave, Box 1047New YorkNY10029

Abstract

Despite the availability of several new systemic agents for psoriasis treatment, choosing the right therapy in certain patient populations can be challenging. There are few up-to-date reviews on systemic drugs for moderate to severe psoriasis in pregnant and pediatric patients and in patients with concomitant chronic infections, such as hepatitis, HIV, and latent tuberculosis. These groups are usually excluded from clinical trials, and much of the available evidence is based on anecdotal case reports and case series. As a chronic disease, psoriasis requires long-term treatment, and there are concerns of adverse maternal–fetal outcomes, long-term side effects in children, and the reactivation of latent infections with the use of systemic agents in these patients. The second article in this continuing medical education series provides insights for choosing appropriate systemic agents for treating moderate to severe psoriasis in pregnant and pediatric patients and in the setting of chronic infections, such as hepatitis, HIV, and latent tuberculosis.

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Keywords : acitretin, adalimumab, apremilast, biologic, brodalumab, certolizumab, cyclosporine, comorbidities, etanercept, golimumab, hepatitis, HIV, IL-12/23, IL-17, IL-23, infliximab, ixekizumab, psoriasis, psoriatic arthritis, methotrexate, pediatric, pregnancy, secukinumab, systemic, TNF-α, traditional agents, tuberculosis, ustekinumab

Abbreviations used : FDA, HBV, HCV, LFT, LTBI, PASI, TNF, VACTERL

Plan

	Funding sources: None.
	Dr Lebwohl is an employee of Mount Sinai and receives research funds from Abbvie, Boehringer Ingelheim, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Leo Pharmaceuticals, MedImmune/AstraZeneca, Novartis, Pfizer, Sciderm, Valeant, and ViDac. Dr Lebwohl is also a consultant for Allergan, Aqua, Boehringer-Ingelheim, LEO Pharma, Menlo, Mitsubishi, Promius, and Theravance. Dr Kaushik has no conflicts of interest to disclose.
	Reprints not available from the authors.
	Date of release: January 2019
	Expiration date: January 2022