A series of critically challenging case scenarios in moderate to severe psoriasis: A Delphi consensus approach - 07/08/11

Doi : 10.1016/j.jaad.2009.03.017

Bruce Strober, MD, PhD ^a,^⁎ , Emily Berger, MD ^b, Jennifer Cather, MD ^f, David Cohen, MD, MPH ^a, Jeffrey J. Crowley, MD ^g, Kenneth B. Gordon, MD ^h, Alice Gottlieb, MD, PhD ^b, Elizabeth J. Horn, PhD ⁱ, Arthur F. Kavanaugh, MD ^j, Neal J. Korman, MD, PhD ^c, Gerald G. Krueger, MD ^d, Craig L. Leonardi, MD ^e, Alan Menter, MD ^k, Sergio Schwartzman, MD ^l, Jeffrey M. Sobell, MD ^b, Melodie Young, MSN, RN, A/GNP-c ^c
^a Department of Dermatology, New York University Medical Center, New York, New York
^b Department of Dermatology, Tufts University–New England Medical Center, Boston, Massachusetts
^c Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
^d Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utahi
^e Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri
^f Modern Dermatology, Dallas, Texas
^g Bakersfield Dermatology & Skin Cancer Medical Group, Bakersfield, California
^h ENH Medical Group, Skokie, Illinois
ⁱ National Psoriasis Foundation, Portland, Oregon
^j Center for Innovative Therapy, University of California, San Diego, Medical Center, San Diego, California
^k Baylor University Medical Center, Dallas, Texas
^l Department of Clinical Medicine, Weil Cornell Medical College, New York Presbyterian Hospital, New York, New York

Reprint requests: Bruce Strober, MD, PhD, 400 E 70th St, Apt 2305, New York, NY 10021.

Résumé

Clinical trials for systemic psoriasis therapy typically enroll healthy patients and exclude patients with cardiovascular disease, latent tuberculosis, liver disease, histories of malignancies, viral infections, children, and pregnant or breast-feeding women. Physicians often require guidance for optimum management of severe psoriasis in patients that have a combination of underlying disease states. To provide treatment recommendations for complex psoriasis scenarios, a consensus panel comprising 15 experts in psoriatic disease convened to review and discuss available evidence-based data and to arrive at a consensus for treatment options of difficult cases. An application of the Delphi Method was used to select case scenarios, provide medical treatment options, present the case study with existing medical evidence, and anonymously vote on treatment options. The top 10 treatment options were ranked and statistically analyzed to compare the differences between treatments. The final rankings and analysis provide guidance for practical, safe, and efficacious treatment options in a number of complex psoriasis scenarios.

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Abbreviations used : ACR, ADEPT, ATS, BCG, BMI, BSA, BTS, CDC, CHF, COPD, CRP, CTCL, ESR, FDA, HBV, HCV, HDL-C, HIV, HL, IBD, IL-6, IMPACT 2, INH, JIA, LCD, LTBI, MM, MMIS, MMR, NAFLD, NASH, NHL, NYHA, PASI, PGA, PPD, PUVA, RA, RCT, SCC, UVB, VZV

Plan

Introduction

Overview of method

Identification process

Live meeting

Statistical analysis

Classification of experimental evidence supporting a therapeutic option

Results

Patients with comorbid infectious disease

Patients with hepatic disease

Patients with cancer

Treatment of moderate to severe psoriasis in the following settings:

Patients who have failed monotherapy

Patients with financial disadvantage

Treatment of psoriasis in the following settings:

Patients with obesity

Treatment of psoriasis in the following setting:

Patients receiving live vaccines

Patients with demyelinating disease

Patients with psoriatic arthritis

Treatment of moderate-to-severe psoriasis in the following settings:

Patients with pregnancy concerns

Pediatric patients

Discussion

	Supported by educational grants from Abbott Laboratories, Astellas, Genentech, and Stiefel Laboratories.
	Funding sources: Abbott, Amgen, Astellas, Celgene, Centocor, Galderma, Genentech, Pharmacare, and Stiefel. Dr Cather has received grants from Amgen. Dr Gottlieb has received research and/or educational grants from Centocor, Amgen, Wyeth, Immune Control, Celgene, Pharmacare, Incyte, and Abbott.
	Disclosure: Dr Strober has been a consultant for Amgen, Abbott, Centocor and a speaker at Amgen, Abbott, Centocor, and Astellas. Dr Berger has no conflict of interest to declare. Dr Cather as served on the advisory boards of Abbott, Centocor, Amgen, Eijai, and has been speaker for Centocor, Abbott, Astellas, Genentech, Eijai, Warner Chilcott; she has also been a consultant for Centocor, Abbott, Astellas. Dr Cohen has served on the advisory boards of Abbott, Amgen, and Stiefel; he has been speaker for Abbott, Amgen, and Stiefel; he has also been a consultant for Stiefel, Galderma, Johnson & Johnson, and Triax. Dr Crowley has been a member of the advisory boards, speaker, and investigator for Amgen, Abbott, and Genentech. Dr Gordon has served on the advisory boards for Abbott, Amgen, Centocor, Genentech, Galderma and has been a consultant/investigator for Abbott, Amgen, Centocor, and Genentech. Dr Gottlieb has been a speaker for Amgen, Wyeth Pharmaceuticals; she has also served on the advisory boards or been a consultant for Amgen, Centocor, Wyeth, Celgene, Bristol Myers Squibb, Beiersdorf, Inc, Warner Chilcott, Abbott, Roche, Sankyo, Medarex, Kemia, Celera, TEVA, Actelion, UCB, Novo Nordisk, Almirall, Immune Control, RxClinical, Medacorp, DermiPsor, Can-Fite, Incyte, Corgentech, and Pfizer. Dr Horn has been a consultant for the International Psoriasis Council. Dr Kavanaugh has been an investigator for Amgen, Abbott, BMS, Centocor, Genentech, Biogen-Idec, and UCB. Dr Korman has been a speaker for Abbott, Amgen, Astellas, Centocor, Genentech, and Novartis; he has also served as consultant and on the advisory boards for Abbott, Amgen, Astellas, Centocor, Genentech, Novartis, Peplin, Watson. Dr Korman has also been an investigator for Abbott, Amgen, Astellas, Celgene, Centocor, Genentech, Genmab, and Novartis. Dr Krueger has no disclosures. Dr Leonardi has served on the advisory boards and been consultant/speaker/investigator for Abbott, Amgen, Centocor, Genetech; he has also been investigator for Allergan, Altana, Alza, Astellas, Celgene, Bristol Myers Squibb, Eli Lilly, Pfizer, Genzyme, CombinatoRx, 3M Pharmaceuticals, Perrigo Israel Pharmaceutical, Schering Plough, RTL, Vitae, and Wyeth. Dr Menter has been on the advisory boards, consultant, speaker, and investigator for Abbott, Amgen, Astellas, Centocor, Genentech, Warner Chilcott, and Wyeth; he has also served on the Advisory Board and been consultant/speaker for Galderma. Dr Schwartzman has been speaker and/or consultant for Abbott, Centocor, Genentech, and UCB. Dr Sobell has served on the advisory board and been consultant/speaker for Amgen, Genentech, Centocor; he has also been consultant/speaker for Abbott. Ms Young has served on the advisory boards and been speaker for Abbott, Centocor, and Genentech; she has served on the advisory board for Amgen and been speaker for Astellas.