Reviewing the Recently Released Psoriasis Guidelines

The National Psoriasis Foundation (NPF) and American Academy of Dermatology (AAD) recently released two joint guidelines for the management and treatment of psoriasis on February 13, 2019. These two guidelines are the first two of series of six guidelines to be released this year. 

We spoke with psoriasis experts Jeffery Weinberg, MD, medical dermatologist at the Mount Sinai School of Medicine, and Megan Noe, MD, MPH, dermatologist at the University of Pennsylvania, to learn more about the new guidelines and how the guidelines aim to improve patient care and outcomes.  

What are some of the common comorbidities associated with psoriasis? 

Dr Weinberg: We have come now to understand psoriasis as a multi-systemic inflammatory disorder rather than just a skin rash. The number one comorbidity associated with it is psoriatic arthritis, which has been reported to occur in up to 40% of cases, but probably more commonly occurs in 15 to 20 percent.

We also know that there are other comorbidities including obesity, metabolic syndrome, cardiovascular risk, Crohn's disease, ulcerative colitis, and many other inflammatory conditions that tend to run side by side.

How does the first new guideline address comorbidities? 

Dr Noe: The guideline entitled “Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities" provides recommendations for dermatologists about how and when to screen for the medical comorbidities commonly seen in patients with psoriasis.  Additionally, there are some recommendations for treatment.

Dr Weinberg: I think what it does is it really lays out, number one, the comorbidities that are there and also, importantly, what it does is it addresses how intervention may affect and ameliorate some of those comorbid risks. It goes item by item looking at the different comorbidities and giving insight into how treatment may be helpful. 

How will the first new guideline help improve patient care? 

Dr Noe: The guidelines are specifically focused on the role of the dermatologist in managing comorbidities associated with psoriasis and provide clear recommendations and the associated level of evidence, helping dermatologists to provide comprehensive care for patients with psoriasis.

Dr Weinberg: I think two things. Guidelines are a very nice collection of information that's in one place so that if somebody says, "You know, I'm thinking about a biologic for this process," and they may be able to use it as a resource.

I also think that guidelines are very useful resources when dealing, for example, with managed care. A justification to use it, if all the information's there and saying, "By the way, we want to use it because it's not just going to have this benefit, but it's also established that it has x, y, or z benefit as well."

How often are biologics used in the treatment of psoriasis? 

Dr Weinberg: More and more. They're being used, I would say, as coverage has become better and as people have become more acclimated to biologics as the mode of therapy. They still have not gone to the point that they're highly, highly prevalent, but I think that certainly there's been an increase in the use. 

How does the second new guideline better highlight biologics better available for psoriasis treatment? 

Dr Noe: The other published guideline “Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics” provides a summary of information regarding the efficacy, effectiveness and adverse effects of the biologics that are FDA-approved for psoriasis. Included in that information are treatment recommendations for individuals with specific medical comorbidities and special situations that may affect treatment choice.

Dr Weinberg: I think also this is a very good review of biologics in one place basically going over a different aspect. What does biologic one to bring to the table? What does biologic two bring to the table? What are the contraindications of certain biologics, when is it good to use them, to not use them?

From that point of view, again, it's good to have all of this in one place as a resource that if I wanted to go look in or educate patients like to pull them aside and go through the pros and cons, because it's all in one place.

Is there anything else you would like to add about the new guidelines? 

Dr Noe: The new guidelines are an important collaboration between the American Academy of Dermatology and the National Psoriasis Foundation to help guide dermatologists summarizing the evidence about not only how to treat psoriasis but also to treat the entire person and improve the overall health for people living with psoriasis. 

Dr Weingberg: Although I was not part of these guidelines, I am on the medical board of the National Psoriasis Foundation. These guidelines are just the first of many that are going to come out in the next few months, over the next year.

These are both educational and tools to help us explain to whoever needs to know why we need to treat what we need to treat, and how we need to treat it.