There are new treatment options for patients with psoriasis.
Treatment options for psoriasis have expanded rapidly in recent years and several new drugs have been licensed in the UK. This is good news for the 2.8% of the UK population who have this chronic and often distressing condition.1
NICE guidance recommends treating mild psoriasis with topical therapies, progressing to phototherapy and systemic treatment for moderate disease, and biological therapies for the most severely affected patients.2 This article will consider new treatment options and potential side effects for primary care professionals to be aware of.
Calcipotriene and betamethasone dipropionate (Enstilar®) foam was introduced in the UK in June 2016. This combination foam gives an alternative option to the gel and ointment formulations available. There is evidence that it has greater bio-availability than the ointment, and patients tend to favour the foam formulation for ease of use.3
Studies comparing calcipotriene and betamethasone dipropionate foam to ointment and placebo were favourable.4-6 Psoriasis Assessment of Severity Index (PASI) scores showed greater improvement for scalp psoriasis at four weeks compared with the ointment, and at eight weeks compared with the gel formulation.
The side effect profile of calcipotriene and betamethasone dipropionate foam is similar to that of other vitamin D/steroid combinations and included itching, erythema and pain at application sites. The treatment can be applied to up to 30% of the body surface area on the trunk and limbs for up to four weeks.
Apremilast (Otezla®) is a new option in the systemic pathway. It is a phosphodiesterase type 4 inhibitor (PDE4) that works intracellularly by increasing cyclic adenosine monophosphate (cAMP) levels and subsequently suppressing interleukin-17 (IL17) and IL23. Both of these mediators appear to play a pivotal role in psoriasis pathogenesis.
Apremilast is licensed for the treatment of both chronic plaque psoriasis and psoriatic arthritis. NICE recommendations for use are summarised in box 1.7
Read full article: New treatments for psoriasis | GPonline
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