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Decision-making algorithm for the management of moderate-to-severe psoriasis: Consensus guidelines from the Center of Evidence of the French Society of Dermatology
| The Center of Evidence of the French Society of Dermatology developed consensus-based guidelines for the treatment of adult patients with moderate-to-severe psoriasis.1 These guidelines follow the 2019 French guidelines, and incorporate the newer interleukin (IL)-23 and IL-17 inhibitors. The guidelines were developed by 35 experts using the Delphi method, and were published in Annales de Dermatologie et de Vénéréologie by Poizeau et al.1 |
| Key learnings |
| The Center of Evidence of the French Society of Dermatology provides a decision-making algorithm, based on consensus statements, for treatment selection for adult patients with moderate-to-severe psoriasis. |
| Methotrexate remains the first-line systemic treatment for moderate-to-severe plaque psoriasis without any contradictions, supported by 89% of experts, reinforcing its role in clinical practice. |
| Newly available IL-17 and IL-23 inhibitors, such as guselkumab, risankizumab, ixekizumab, and secukinumab, were recommended by 91%, 85%, 83%, and 82% of experts, respectively, for second-line treatment of patients with non-biologic treatment failure or intolerance, and are favored over tumor necrosis factor (TNF) inhibitors and IL-12/23 inhibitors, reflecting their superior efficacy in recent clinical trials. TNF inhibitors were recommended for patients with cardiovascular risk factors. |
| Cyclosporine is recommended for rapidly progressive forms of psoriasis, such as pustular and erythrodermic psoriasis, with specific endorsement for pregnant patients or those planning pregnancy, emphasizing its value in urgent or specific patient scenarios. |
| This decision-making algorithm provides a structured approach to the management of moderate-to-severe psoriasis, ensuring clinicians can integrate the latest consensus into personalized patient care and improved therapeutic outcomes. |
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