Differential management of mild-to-severe psoriasis with biologic drugs: An Italian Delphi consensus expert panel

Abstract

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.

• Clinical recommendations
• survey
• treatment choice

Declaration of interest

G.G. has received lecture and/or consultation fees from Pfizer, Novartis, Abbvie, Janssen, Eli-Lilly, MSD, Almirall and Celgene. A.F. has been consultant for Abbott, Janssen-Cilag, MSD, Novartis, Pfizer and has received support for travel to meeting from the above mentioned companies. C.S. has been consultant and/or speaker for Merck, Pfizer, Abbvie, Novartis, Janssen-Cilag and Leo Pharma. P.A. has received fees as speaker or consultant or has received research or educational support for the Dermatology Unit of the Department of Medicine of the University of Padua from: Abbott, Almirall, MSD, Janssen-Cilag, Pfizer, GSK and Leo Pharma. V.G.A. has been a speaker, consultant and/or a member of Advisory Board for Abbvie, MSD, Novartis, Pfizer, Janssen-Cilag and Leo Pharma. Medical writing support was provided by Mary Hines on behalf of Health Publishing & Services Srl, Milano, Italia. This was funded by Pfizer. The manuscript is supported by an unrestricted educational grant from Pfizer Italia.