Differential management of mild-to-severe psoriasis with biologic drugs: An Italian Delphi consensus expert panel.
BACKGROUND
In the management of moderate-to-severe psoriasis, increasingly complex clinical scenarios necessitate practical tools for appropriate biologic therapy selection in individual patients. An Italian Delphi consensus panel provided guidance on biologic use in selected clinical scenarios.


METHODS
Ten experts defined statements under consideration, which were distributed as an online survey to a dermatologist panel. Plenary discussions of contentious statements were held to achieve consensus.


RESULTS
The survey was sent to 30 clinicians. After plenary discussions, consensus was reached on all 20 statements on the following topics: special populations; infections; comorbidities; immunogenicity; extra-cutaneous involvement; pregnancy; and adherence. Three statements required further discussion in order to gain consensus: use of subcutaneous biologics in mild liver impairment (final 94% agreement), use of any biologic in discoid lupus erythematosus (final 100% disagreement), and use of etanercept in patients with history of hypersensitivity reactions to drugs and/or food (final 75% disagreement).


CONCLUSIONS
This Delphi expert consensus on the use of biologics in psoriasis provides practical recommendations for dermatologists to use when choosing an appropriate biologic in challenging but common clinical scenarios. More data are required to clarify clinical differences of biologic drugs used to treat psoriasis.
Department of Medicine, Section of Dermatology and Venereology, University of Verona , Verona , Italy .
Giampiero
G
Girolomoni
Gianfranco
G
Altomare
Fabio
F
Ayala
Enzo
E
Berardesca
Piergiacomo
P
Calzavara Pinton
Sergio
S
Chimenti
Patrizia
P
Martini
Andrea
A
Peserico
Antonio
A
Puglisi Guerra
Gino Antonio
GA
Vena
D001688:Biological Products / Q000627:therapeutic use*; D001691:Biological Therapy / Q000379:methods*; D032921:Consensus; D000068800:Etanercept / Q000627:therapeutic use; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy* / Q000503:physiopathology; D011795:Surveys and Questionnaires
D001688:Biological Products; D000068800:Etanercept
Clinical recommendations; survey; treatment choice