Guidelines for Biologic Therapy for Psoriasis 2020

Table 1. Strength of recommendation ratings
Strength	Wording	Symbols	Definition
Strong recommendation for the use of an intervention	'Offer' (or similar, e.g. 'provide', 'advise', 'screen')	↑↑	Benefits of the intervention outweigh the risks; most patients would choose the intervention while only a small proportion would not; for clinicians, most of their patients would receive the intervention; for policymakers, it would be a useful performance indicator
Weak recommendation for the use of an intervention	'Consider'	↑	Risks and benefits of the intervention are finely balanced; many patients would choose the intervention but many would not; clinicians would need to consider the pros and cons for the patient in the context of the evidence; for policymakers, it would be a poor performance indicator where variability in practice is expected
No recommendation		Θ	Insufficient evidence to support any recommendation
Strong recommendation against the use of an intervention	'Do not offer'	↓↓	Risks of the intervention outweigh the benefits; most patients would not choose the intervention while only a small proportion would; for clinicians, most of their patients would not receive the intervention

Table 2. Dose-escalation/interval-reduction strategy
Biological agent	Suggested dose-escalation/interval-reduction strategy
Adalimumab 40 mg every other week	Adalimumab 40 mg weekly
Certolizumab pegol 200 mg every 2 weeks	Certolizumab pegol 400 mg every 2 weeks
Etanercept 50 mg once weekly	Etanercept 50 mg twice weekly
Infliximab 5 mg kg⁻¹ every 8 weeks	aInfliximab 5 mg kg⁻¹ every 6 weeks
Ixekizumab 80 mg every 4 weeks	aIxekizumab 80 mg every 2 weeks
Tildrakizumab 100 mg every 12 weeks	Tildrakizumab 200 mg every 12 weeks (high disease burden or ≥ 90 kg)
Ustekinumab 45 mg every 12 weeks (≤ 100 kg)	aUstekinumab 90 mg every 8 or 12 weeks (≤ 100 kg)
Ustekinumab 90 mg every 12 weeks (> 100 kg)	aUstekinumab 90 mg every 8 weeks (> 100 kg)

^aOff-license use.

Authors and Disclosures

C.H. Smith¹, Z.Z.N. Yiu², T. Bale³, A.D. Burden⁴, L.C. Coates^5,6, W. Edwards⁷, E. MacMahon⁸, S.K. Mahil¹, A. McGuire⁹, R. Murphy^10–12, C. Nelson-Piercy¹³, C.M. Owen¹⁴, R. Parslew¹⁵, O.A. Uthman¹⁶, R.T. Woolf¹, L. Manounah¹⁷, M.C. Ezejimofor¹⁷, L.S. Exton¹⁷ and M.F. Mohd Mustapa¹⁷ on behalf of the British Association of Dermatologists' Clinical Standards Unit

¹St John's Institute of Dermatology, ⁸Department of Infectious Diseases, ⁹Pharmacy Department and ¹³Women's Health Academic Centre; Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
²Dermatology Centre Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester M13 9PT, UK
³British Dermatology Nursing Group representative Aneurin Bevan Health Board, Wales, UK
⁴Institute of Infection, Immunity and Inflammation University of Glasgow Glasgow G12 8QQ, UK
⁵British Society for Rheumatology, London EC4Y 8EE, UK
⁶Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Oxford OX3 7LD, UK
⁷Patient representative
¹⁰Department of Dermatology Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
¹¹Department of Dermatology Sheffield Children's NHS Foundation Trust, Sheffield S10 3FL, UK
¹²University of Nottingham University Park, Nottingham NG7 2RD, UK
¹⁴Department of Dermatology East Lancashire Hospitals NHS Trust, Burnley BB10 2PQ, UK
¹⁵Department of Dermatology Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
¹⁶Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
¹⁷British Association of Dermatologists, London W1T 5HQ, UK

Correspondence
Catherine H. Smith. Email: catherine.smith@kcl.ac.uk; guidelines@bad.org.uk

Conflicts of interest
Details of declarations of interests (cumulative, throughout the project) can be found in File S2: Appendix L and are consistent with the NICE Accreditation policy.

T.B., A.D.B., L.C.C., W.E., E.M., S.K.M., A.M., R.M., C.N.-P., C.M.O., R.P., O.A.U. and R.T.W. contributed equally to this project and are listed alphabetically.

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