title: Strategy to manage the treatment of severe psoriasis: considerations of efficacy, safety and cost.
abstract: 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.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA. sfeldman@wfubmc.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Rachel
authors.initials: R
authors.lastname: Garton
authors.forename: William
authors.initials: W
authors.lastname: Averett
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vallee
mesh_terms: 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*
chemical_list: D003879:Dermatologic Agents; D017319:Photosensitizing Agents