Plaque psoriasis is the most common form of the disease, affecting 80% to 90% of patients and manifesting as sharply demarcated, scaling, and erythematous lesions that vary in shape and size.1,5,6 Multiple comorbidities, including cardiovascular disease, diabetes, metabolic syndrome, and renal disease, increase the disease burden beyond the realm of the skin, particularly with more severe disease.2,3,6,7
The majority of patients seen in clinical practice have mild psoriasis, and only about 20% to 25% have moderate-to-severe disease.3,8 The Psoriasis Area and Severity Index (PASI) is among the most commonly used tools for monitoring response to treatment in clinical trials.9,10 However, it is rarely used by dermatologists to guide disease management because it can be impractical to implement in clinical practice.9-11 Measures such as the Physician’s Global Assessment (PGA), the percent of body surface area (BSA) involvement, and composite BSA×PGA scores are other commonly used assessment tools,6,10,12 with BSA being the most preferred instrument for evaluating patient responses.13
Because there is no cure for psoriasis, treatment strategies aim to clear active disease sites and prolong symptom-free periods.8 Topical medications or phototherapy are sufficient therapeutic interventions for the majority of patients with limited disease.8,9,14 However, more extensive disease often requires the use of systemic therapies, such as retinoids, methotrexate, cyclosporine, or acitretin, or biologic immune-modifying agents.3,8,9,15 In recent years, newer therapies for moderate-to-severe psoriasis have become available, primarily through the development of biologics targeting tumor necrosis factor (TNF), interleukin (IL)-12/23, IL-23, and IL-17.3 Because of their specificity, biologic treatments for psoriasis are considered safer than some of the traditional systemics,16 and this has pushed them to the forefront in treating moderate-to-severe psoriasis.8,9
Despite their availability and overall success in treating psoriasis, there are many unanswered questions regarding how to appropriately match specific biologics to individual patients. Numerous randomized, controlled trials have demonstrated the efficacy of the different biologics against placebo, but the relative benefit of individual biologics remains unclear due to the limited number of head-to-head trials; comparative data in a real-world setting are even more sparse. Additionally, relevant practical information on chronic disease management with biologics is lacking.