a safe and effective alternative for patients with beyond-mild psoriasis. By various definitions of severity (PGA, BSA, and/ or Rule-of-Tens), Cal/BD foam has consistently been shown to improve treatment outcomes in patients with beyond-mild psoriasis. In MAIC comparisons, Cal/BD yielded higher response rates compared with either apremilast or acitretin. Cal/BD foam also demonstrated lower costs per responder compared with apremilast. In the absence of formal comparative trials, claims of superiority cannot be made. However, together, these data for Cal/BD foam challenge conventional recommendations that limit the use of topical monotherapy to milder forms of psoriasis.1 Cal/BD foam may be considered among the first-line therapies for beyond-mild psoriasis. Specifically, Cal/BD foam may be preferable to oral agents such as apremilast or acitretin.
The practicality of applying topical agents in psoriasis involving a large BSA is an important issue. However, the administration of Cal/BD foam via an aerosol spray allows it to be applied to large surface areas with relative ease. Moreover, Cal/BD foam is administered once daily,10 unlike many other topical agents that require twice-daily application.2 Therefore, having a high BSA involvement at presentation should not preclude the use of Cal/ BD foam in patients who are otherwise deemed candidates for this medication. Additionally, Cal/BD foam is associated with a rapid onset of action; the median time to mPASI50 in the PSO-FAST trial was 2.1 weeks, with 65.5% and 82.3% of patients treated with Cal/BD foam achieving mPASI50 by week 2 and week 4, respectively.39 This suggests that use of Cal/BD foam in patients with extensive disease has the potential to quickly reduce BSA involvement to a more mild to moderate range. At that point, patients have the option to switch treatment or continue with Cal/BD foam, if they desire to avoid oral and biologic medications.
For patients with psoriasis that cannot be effectively managed with oral or biologic medication alone, existing data suggest that adjunctive therapy with Cal/BD foam may improve treatment outcomes with minimal AEs. Adjunctive therapy may offer several advantages that should be considered before switching oral or biologic therapy, including quick symptom relief while patients await laboratory results and/or insurance approval, as well as avoidance of complications that may potentially result from new therapies (eg, lack of response, systemic AEs, development of neutralizing antibodies, worsening of symptoms). Additionally, the ability to discontinue and reinitiate Cal/BD foam without apparent loss of efficacy is conducive to a more flexible treatment plan.
DISCUSSION AND CONCLUSIONS
Despite decades of research, the availability of effective, safe,
and affordable treatment options remains an unmet need for
many patients with psoriasis. For those with beyond-mild
psoriasis, who may be burdened with greater discomfort and
comorbidities, higher cost of treatment, and adverse reactions
