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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 7 novembre 2019
Doi : 10.1016/j.jaad.2019.05.056
accepted : 23 May 2019
Management of pediatric plaque psoriasis using biologics

Perla Lansang, MD a, b, c, , James N. Bergman, MD d, Loretta Fiorillo, MD e, Marissa Joseph, MD b, c, Irene Lara-Corrales, MSc, MD c, Danielle Marcoux, MD f, Catherine McCuaig, MD f, Elena Pope, MSc, MD c, Vimal H. Prajapati, MD g, Sue Z.J. Li, PhD h, Ian Landells, MD i
a Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada 
b Women's College Hospital, University of Toronto, Toronto, Ontario, Canada 
c Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 
d Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada 
e Division of Pediatric Dermatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada 
f Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada 
g Division of Dermatology, Department of Medicine, and Divisions of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary; and Dermatology Research Institute, Calgary, Alberta, Canada 
h Janssen Inc, Toronto, Ontario, Canada 
i Memorial University of Newfoundland and Nexus Clinical Research, St John's, Newfoundland, Canada 

Correspondence to: Perla Lansang, MD, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room M1-726, Toronto, ON M4N 3M5, Canada.Sunnybrook Health Sciences Centre2075 Bayview Ave, Room M1-726TorontoONM4N 3M5Canada

Psoriasis is a chronic inflammatory disease with clinical manifestations of the skin that affect adults and children. In adults, biologics have revolutionized the treatment of moderate to severe plaque psoriasis where clear or almost clear is a tangible goal. Research on biologics has recently been extended to children. The introduction of these new therapeutic options has outpaced the limited guidelines in this population.


To provide a review of current data on biologics, with a proposal for a clinically relevant treatment algorithm on the management of moderate to severe plaque psoriasis in the pediatric population.


A Canadian panel with expertise in psoriasis, pediatric dermatology, and experience with consensus recommendation processes was selected to review the current landscape of pediatric psoriasis and clinical data on biologics plus identify special considerations for baseline workup and monitoring. Recommendations were reviewed and edited by each expert in an iterative process.


A treatment algorithm for moderate to severe plaque psoriasis in pediatric patients is presented, incorporating approved biologics. Guidance on baseline screening and ongoing monitoring is also provided. Ultimately, treatment choice depends on the patient and his or her caregiver, with consideration of comorbidities, impact on quality of life, and relevant safety aspects.

The full text of this article is available in PDF format.

Key words : adolescent, biologics, children, monitoring, pediatric, psoriasis, systemic therapy

Abbreviations used : AEs, IL, MTX, PASI, RCTs, TB, Th 17, TNF-α

 Funding sources: The authors first discussed this topic at an advisory board convened by Janssen Inc Canada on September 16, 2016. Janssen Inc Canada did not provide financial writing support to any of the authors.
 Conflicts of interest: Dr Lansang: Consultant, speaker, or advisory boards for Amgen, AbbVie, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, and Valeant. Dr Bergman: Advisory board and/or speaker for Aralez, Cipher, Galderma, GSK, Janssen, LEO Pharma, Novartis, Pfizer, and Valeant. Dr Fiorillo: Investigator for Celgene and Pfizer and advisory boards for Janssen, Novartis, Amgen, and AbbVie. Dr Joseph: Consultant, speaker, or advisory board for Janssen, Novartis, Amgen, and AbbVie. Dr Lara-Corrales: Advisory boards, consultant, speaker, and/or investigator for AbbVie, Amgen, Celgene, Janssen, LEO Pharma, Eli Lilly, and AbbVie; and consultant, speaker, or advisory boards for Janssen, Amgen, Pfizer, Novartis, AbbVie. Dr Marcoux: Investigator for Galderma, LEO Pharma, Eli Lily, AbbVie, Celgene, and Janssen; advisory boards for Galderma, LEO Pharma, Eli Lilly, AbbVie, Celgene, Janssen, and Amgen; and speaker for AbbVie, LEO Pharma, and Celgene. Dr McCuaig: Advisory boards for Janssen, Novartis, Amgen, AbbVie, and Celgene. Dr Pope: Investigator for Amgen and Centocor and advisory board for Janssen. Dr Prajapati: Investigator for AbbVie, Asana, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, and Regeneron; and consultant, advisor, and/or speaker for AbbVie, Actelion, Amgen, Aralez, Aspen, Celgene, Cipher, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Janssen, LEO Pharma, L'Oreal, Novartis, Pfizer, Sanofi Genzyme, Tribute, and Valeant. Dr Li is an employee of Janssen Inc Canada. Dr Landells: Investigator for Janssen and Eli Lily, and consultant, advisor, and/or speaker for AbbVie, Eli Lilly, Janssen, Novartis, and Celgene.
 Reprints are not available from the authors.

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