British Association of Dermatologists Guidelines for Biologic Therapy for Psoriasis 2020

A Rapid Update

C.H. Smith; Z.Z.N. Yiu; T. Bale; A.D. Burden; L.C. Coates; W. Edwards; E. MacMahon; S.K. Mahil; A. McGuire; R. Murphy; C. Nelson-Piercy; C.M. Owen; R. Parslew; O.A. Uthman; R.T. Woolf; L. Manounah; M.C. Ezejimofor; L.S. Exton; M.F. Mohd Mustapa


The British Journal of Dermatology. 2020;183(4):628-637. 

In This Article

Purpose and Scope of the Guideline

The overall aim of the guideline is to provide up-to-date, evidence-based recommendations on the use of biologic therapies targeting tumour necrosis factor (TNF) (adalimumab, etanercept, certolizumab pegol, infliximab), interleukin (IL)-12/23p40 (ustekinumab), IL-17A (ixekizumab, secukinumab), IL-17RA (brodalumab) and IL-23p19 (guselkumab, risankizumab, tildrakizumab) in adults, children and young people for the treatment of psoriasis; consideration is given to the specific needs of people with psoriasis and psoriatic arthritis. This rapid update is part of an annual evidence review to factor in the latest evidence for biological drugs evaluated in the 2017 publication of the guideline,[1] and newer biological drugs that have been licensed for psoriasis in the UK or are expected to be licensed in the near future.

This set of guidelines has been developed using the recommended methodology of the British Association of Dermatologists (BAD)[2] with reference to the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument (,[3] and the Grading of Recommendations Assessment, Development and Evaluation (GRADE).[4] Additional online Supporting Material includes our Implementation Toolkit (File S1), Appendices (File S2), and Audit standards and methodology (File S3). Further information on the guideline development process can be found in Appendix I (File S2; see Supporting Information). The multidisciplinary guideline development group (GDG) comprised medical specialists (consultants in dermatology, paediatric dermatology, rheumatology, virology and obstetric medicine), a clinical nurse specialist, dermatology trainees, a pharmacist specialist, a patient representative and a research team providing technical and methodological support [a full list of GDG members can be found in Appendix K (File S2; see Supporting Information)].

The recommendations were developed for implementation in the National Health Service (NHS) in the UK. The guideline recommendations will normally fall within licensed indications; exceptionally, and only if clearly supported by evidence, use outside a licensed indication may be recommended. The guideline assumes that prescribers cross-reference a drug's summary of product characteristics (SPC) to inform clinical decision making for individual patients. Where relevant, this guidance applies to biosimilars (similar biological medical products), subject to recommendations given within the BAD position statement and the European Medicines Agency guidelines.[5,6] This guidance does not cover agents licensed outside the UK or use of biologic therapies for indications other than psoriasis, or use when psoriatic arthritis is the main indication.