Management of Moderate to Severe Plaque Psoriasis With Biologic Therapy

The impact of this debilitating disease has been largely underestimated, yet new biologic agents offer significant clinical benefit to those afflicted.
Professor, Department of Dermatology, Eastern Virginia Medical School, Norfolk, Va.
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Plaque psoriasis, also referred to as psoriasis vulgaris, afflicts upwards of seven million Americans (Koo 1996). Because psoriasis is a cutaneous disorder, many have underestimated its medical impact (Weiss 2002). Nevertheless, many patients are hospitalized each year due to complications related to psoriasis and its treatment, and approximately 350 patients die annually from related causes. The overall costs associated with psoriasis management are significant, possibly exceeding $3 billion annually (National Psoriasis Foundation 2001).

Because the manifestations of psoriasis are obvious and visible, this disease has a profound psychosocial impact. Notably, the results of a questionnaire revealed that patients with psoriasis reported reduction in physical and mental functioning similar to that observed in patients with other major medical illnesses, including cancer, arthritis, hypertension, heart disease, diabetes, and depression (Rapp 1999).

In the last decade, a new understanding about the pathophysiology of psoriasis has resulted in the development of a new class of agents for these patients: targeted biologic therapy. These novel treatments target specific immunologic processes involved in the genesis of this disease, providing significant clinical benefit to psoriasis sufferers. The American Academy of Dermatology (AAD) Consensus Statement places biologic therapies among the currently approved systemic treatments for patients with widespread disease.

This paper has undergone peer review by appropriate members of Managed Care’s Editorial Advisory Board.