Changing Psoriasis Treatments in Light of New AAD Guidelines
The American Academy of Dermatology (AAD) summer meeting was held last month in New York City, where new psoriasis and psoriatic treatment guidelines were discussed. Changes have been made throughout AAD guidelines covering treatment with biologics, topical therapy, systemic agents, phototherapy and ultraviolet light therapy.
The most practical change was for those patients being treated with methotrexate (MTX), who now no longer need liver biopsies if they do not show risk for cirrhosis.
Two identical surveys were conducted, one before the session and the other after, as well as a panel discussion to assess the impact of the meeting. Another follow-up survey will be distributed six-months after the forum to gauge the success of forum to clinic translation.
The following are topics discussed at the AAD Summer Academy meeting, emphasized by facts sampled from Sections 1-6 of the current approved and published guidelines on psoriasis and psoriatic arthritis.
1. Elimination of Repeated Liver Biopsy
Old: Follow-up liver biopsy for every 1-1.5 grams of methotrexate dosed
New: At a dose of 3.5-4.0 g of MTX, there are now three options for patients without obesity, diabetes, hyperlipidemia or other hepatic toxicity risk factors. Options suggested with presence of normal liver chemistry test results include: (1) perform liver biopsy, (2) monitor without biopsy, or (3) switch to alternative therapy when possible.
Patients on MTX should be referred to a hepatologist to guide liver biopsy requirement.
(Read more on page 19 in Section 6 of the guidelines)
2. Special Circumstances Discussed: Patients with Multiple Sclerosis (MS)
Demyelinating disorders such as MS have shown to develop and worsen in patients taking TNF antagonists. Personal and medical history should be taken into account with patients taking TNF, as it has shown to increase risk of the disease in first-degree relatives of MS patients.
(Read more on page 17 in Section 1 of the guidelines)
3. Phototherapy Recommendation: Reduce psoralen and ultraviolet A (PUVA) treatments to decrease the long-term risk of skin cancer.
The past 25 years has shown evidence for an increased risk of skin cancer for Caucasian PUVA-treated patients.
(Read more on page Pg 11 in Section 6 of the guidelines)