Strategy to manage the treatment of severe psoriasis: considerations of efficacy, safety and cost.
Psoriasis is a common, unpredictable, chronic immune-mediated disease characterised by skin lesions and frequently associated with arthritis. Although rarely fatal, psoriasis has a tremendous impact on a patients' quality of life. Traditional therapies for severe psoriasis include phototherapy, methotrexate, oral retinoids and cyclosporin. New biological agents add to the treatment options for psoriasis; however, they raise the already considerable cost of managing the disease. In considering efficacy, safety and cost-effectiveness, ultraviolet Type B (UVB) phototherapy appears to be the best first-line agent for the control of psoriasis. Methotrexate, psoralen plus UVA, alefacept, etanercept and infliximab are appropriate second-line agents, the choice of which requires considerable patient input and physician judgement. Developing rational, effective and acceptable strategies to manage psoriasis treatments would encourage cost-effective psoriasis management.
Feldman
Steven R
SR
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA. sfeldman@wfubmc.edu
Garton
Rachel
R
Averett
William
W
Balkrishnan
Rajesh
R
Vallee
Jeffrey
J
D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D018803:Models, Economic; D011701:PUVA Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D010789:Phototherapy / Q000009:adverse effects / Q000191:economics*; D011565:Psoriasis / Q000188:drug therapy / Q000191:economics / Q000628:therapy*
D003879:Dermatologic Agents; D017319:Photosensitizing Agents