title: An evolution in switching therapy for psoriasis patients who fail to meet treatment goals.
abstract: Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients' cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end-organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near-complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate-to-severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients' psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patient's clinical needs and treatment preferences.
authors.affiliation: Department of Dermatology, Larkin Community Hospital, Miami, Florida.|The Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Francisco
authors.initials: F
authors.lastname: Kerdel
authors.affiliation: The Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Martin
authors.initials: M
authors.lastname: Zaiac
mesh_terms: D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D006801:Humans; D055118:Medication Adherence; D010347:Patient Care Planning; D017060:Patient Satisfaction; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D017211:Treatment Failure
chemical_list: D003879:Dermatologic Agents
keywords: disease management; efficacy; psoriasis; strategies; switching; treatment goals