What are the treatment guidelines for moderate-to-severe plaque psoriasis?

Updated: Mar 17, 2021
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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A 2013 international consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis include the following recommendations [7] :

  • Methotrexate, for as long as it remains effective and well-tolerated

  • Cyclosporine, generally used intermittently for inducing a clinical response with one or several courses over 3-6 months

  • Transition from conventional systemic therapy to a biologic agent, either directly or with an overlap if transitioning is needed due to lack of efficacy, or with a treatment-free interval if transitioning is needed for safety reasons

  • Combination therapy

  • Continuous therapy for patients receiving biologic agents

  • Switching biologic agents: If due to lack of efficacy, perform without a washout period; if for safety reasons, a treatment-free interval may be required

  • Combinations of multiple agents (eg, methotrexate and a biologic) are necessary in some patients but the long-term safety and optimal laboratory monitoring have yet to be defined

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