[en] Targeted biologic drugs and small molecules have transformed the psoriasis treatment landscape in recent years. The Belgian healthcare system, in common with many others across Europe, must balance the burgeoning use of these transformative, yet expensive, drugs with the sustainable use of limited resources. Drawing on recent updates to the EuroGuiDerm and the German S2 psoriasis guidelines, eight Belgian dermatologists experienced in treating patients with psoriasis undertook a quasi-Delphi initiative to provide perspectives on the current opportunities and challenges in psoriasis. This update focuses on responsible ways to rationalize the use of innovative treatments (e.g. biologics and small molecules). Inherently, this required viewpoints on the International Psoriasis Council's new definition of severe psoriasis, defining psoriasis severity and the concept of treating to target. It discusses the appropriateness of using older biologics classes, biosimilars and personalized dosing and lastly, how teledermatology may play a role in providing sustainable, patient-centric psoriasis care. In addition, this manuscript includes the updated Belgian evidence-based treatment advice in psoriasis (BETA-PSO) to reflect recent data and drug approvals. The recommendations reflect the best practices for clinicians when using systemic and biologic therapies to treat patients with psoriasis and offer guidance on how they may prescribe these drugs sustainably and efficiently.
Disciplines :
Dermatology
Author, co-author :
Speeckaert, R ; Department of Dermatology, Ghent University Hospital, Ghent, Belgium
Nikkels, Arjen ; Université de Liège - ULiège > Département des sciences cliniques > Dermatologie
Lambert, J ; Department of Dermatology, University Hospital of Antwerp, Antwerp, Belgium
Benhadou, F; Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
Reynaert, V ; Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
Ghislain, P D; Department of Dermatology, Cliniques Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
Hillary, T ; Department of Dermatology, University Hospital Leuven, Leuven, Belgium
Lambert, J L W; Department of Dermatology, Ghent University Hospital, Ghent, Belgium
Language :
English
Title :
Belgian recommendations for managing psoriasis in a changing treatment landscape.
Publication date :
March 2025
Journal title :
Journal of the European Academy of Dermatology and Venereology
KBVDV - Koninklijke Belgische Vereniging voor Dermatologie en Venerologie
Funding text :
The authors wish to thank Keena McKillen PhD (CCN17 Ltd., Cambridge, UK) and Alice Kirk (Kirk MedComms Ltd., Cambridge, UK) for preparing the manuscript and providing editorial assistance. These services were funded by were funded by the Royal Belgian Society of Dermatology and Venerology, in accordance with Good Publication Practice guidelines (www.ismpp.org/gpp-2022).Funding for this project was provided from the Royal Belgian Society of Dermatology and Venereology's project partnership programme.
Mahil SK, Wilson N, Dand N, Reynolds NJ, Griffiths CEM, Emsley R, et al. Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study (the British Association of Dermatologists biologics and immunomodulators register, BADBIR). Br J Dermatol. 2020;182:1158–1166.
Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, et al. Recategorization of psoriasis severity: Delphi consensus from the international psoriasis council. J Am Acad Dermatol. 2020;82:117–122.
Grine L, de la Brassinne M, Ghislain PD, Hillary T, Lambert J, Segaert S, et al. A Belgian consensus on the definition of a treat-to-target outcome set in psoriasis management. J Eur Acad Dermatol Venereol. 2020;34:676–684.
Gisondi P, Talamonti M, Chiricozzi A, Piaserico S, Amerio P, Balato A, et al. Treat-to-target approach for the Management of Patients with moderate-to-severe plaque psoriasis: consensus recommendations. Dermatol Ther (Heidelb). 2021;11:235–252.
British Association of Dermatologists (BAD). Teledermatology. 2023 Available from: https://www.bad.org.uk/clinical-services/teledermatology/ [Accessed August 2023]
Kips J, Lambert J, Ongenae K, De Sutter A, Verhaeghe E. Teledermatology in Belgium: a pilot study. Acta Clin Belg. 2020;75:116–122.
López Seguí F, Franch Parella J, Gironès García X, Mendioroz Peña J, García Cuyàs F, Adroher Mas C, et al. A cost-minimization analysis of a medical record-based, store and forward and provider-to-provider telemedicine compared to usual Care in Catalonia: more agile and efficient, especially for users. Int J Environ Res Public Health. 2020;17:2008.
Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F, Mendioroz Peña J, Flores Mateo G, Deniel Rosanas J, et al. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv Res. 2018;18:650.
Eminović N, Dijkgraaf MG, Berghout RM, Prins AH, Bindels PJ, de Keizer NF. A cost minimisation analysis in teledermatology: model-based approach. BMC Health Serv Res. 2010;10:251.
Pala P, Bergler-Czop BS, Gwiżdż J. Teledermatology: idea, benefits and risks of modern age – a systematic review based on melanoma. Postepy Dermatol Alergol. 2020;37:159–167.
Lambert JLW, Segaert S, Ghislain PD, Hillary T, Nikkels A, Willaert F, et al. Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA-PSO: Belgian evidence-based treatment advice in psoriasis; part 2). J Eur Acad Dermatol Venereol. 2020;34:1914–1923.
Lambert JLW, Segaert S, Ghislain PD, Hillary T, Nikkels A, Willaert F, et al. Practical recommendations for systemic treatment in psoriasis according to age, pregnancy, metabolic syndrome, mental health, psoriasis subtype and treatment history (BETA-PSO: Belgian evidence-based treatment advice in psoriasis; part 1). J Eur Acad Dermatol Venereol. 2020;34:1654–1665.
Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, et al. EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris–part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol. 2020;34:2461–2498.
Nast A, Altenburg A, Augustin M, Boehncke WH, Harle P, Klaus J, et al. German S3-guideline on the treatment of psoriasis vulgaris, adapted from EuroGuiDerm - part 2: treatment monitoring and specific clinical or comorbid situations. J Dtsch Dermatol Ges. 2021;19:1092–1115.
Nast A, Altenburg A, Augustin M, Boehncke WH, Harle P, Klaus J, et al. German S3-guideline on the treatment of psoriasis vulgaris, adapted from EuroGuiDerm - part 1: treatment goals and treatment recommendations. J Dtsch Dermatol Ges. 2021;19:934–150.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926.
Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CE, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res. 2011;303:1–10.
Dauden E, Puig L, Ferrandiz C, Sanchez-Carazo JL, Hernanz-Hermosa JM, Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology. Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: psoriasis Group of the Spanish Academy of dermatology and venereology. J Eur Acad Dermatol Venereol. 2016;30(Suppl 2):1–18.
Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD, et al. From the medical Board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76:290–298.
Gulliver W, Lynde C, Dutz JP, Vender RB, Yeung J, Bourcier M, et al. Think beyond the skin: 2014 Canadian expert opinion paper on treating to target in plaque psoriasis. J Cutan Med Surg. 2015;19:22–27.
Carretero G, Carrascosa JM, Puig L, Sanchez-Carazo JL, Lopez-Ferrer A, Cueva P, et al. Definition of minimal disease activity in psoriasis. J Eur Acad Dermatol Venereol. 2021;35:422–430.
Felix PAO, Sampaio AL, Silva BL, Viana ALP. Early intervention in psoriasis: where do we go from here? Front Med (Lausanne). 2022;9:1027347.
Seston EM, Ashcroft DM, Griffiths CE. Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis. Arch Dermatol. 2007;143:1175–1179.
Godman B, Bucsics A, Vella Bonanno P, Oortwijn W, Rothe CC, Ferrario A, et al. Barriers for access to new medicines: searching for the balance between rising costs and limited budgets. Front Public Health. 2018;6:328.
Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, et al. Pharmaceutical regulation in 15 European countries review. Health Syst Transit. 2016;18:1–122.
Evans C. Managed care aspects of psoriasis and psoriatic arthritis. Am J Manag Care. 2016;22:s238–s243.
Burgos-Pol R, Martínez-Sesmero JM, Ventura-Cerdá JM, Elías I, Caloto MT, Casado M. The cost of psoriasis and psoriatic arthritis in 5 European countries: a systematic review. Actas Dermosifiliogr. 2016;107:577–590.
Hilhorst N, Roman E, Borzée J, Deprez E, Hoorens I, Cardoen B, et al. Value in psoriasis (IRIS) trial: implementing value-based healthcare in psoriasis management - a 1-year prospective clinical study to evaluate feasibility and value creation. BMJ Open. 2023;13:e067504.
Finlay AY. Current severe psoriasis and the rule of tens. Br J Dermatol. 2005;152:861–867.
Vide J, Magina S. Moderate to severe psoriasis treatment challenges through the era of biological drugs. An Bras Dermatol. 2017;92:668–674.
Makurvet FD. Biologics vs. small molecules: drug costs and patient access. Med Drug Discov. 2021;9(100075):100075.
Driessen RJB, Bisschops LA, Adang EMM, Evers AW, Van De Kerkhof PCM, De Jong EMGJ. The economic impact of high-need psoriasis in daily clinical practice before and after the introduction of biologics. Br J Dermatol. 2010;162:1324–1329.
Wu JJ, Pelletier C, Ung B, Tian M. Real-world treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriasis. J Med Econ. 2019;22:365–371.
Mahlich J, Alba A, Hadad LE, Leisten M-K, Peitsch WK. Drug survival of biological therapies for psoriasis treatment in Germany and associated costs: a retrospective claims database analysis. Adv Ther. 2019;36:1684–1699.
Ferrándiz C, García A, Blasco AJ, Lázaro P. Cost-efficacy of adalimumab, etanercept, infliximab and ustekinumab for moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2012;26:768–777.
Gniadecki R, Thio B. Cost-effectiveness of biologics for moderate-to-severe psoriasis from the perspective of the swiss healthcare system. Eur J Dermatol. 2009;19:494–499.
Nyholm N, Schnack H, Danø A, Skowron F. Cost per responder of biologic drugs used in the treatment of moderate-to-severe plaque psoriasis in France and Germany. Curr Med Res Opin. 2023;39:833–842.
Reid C, Griffiths CEM. Psoriasis and treatment: past, present and future aspects. Acta Derm Venereol. 2020;100:adv00032.
Fonia A, Jackson K, Lereun C, Grant DM, Barker JN, Smith CH. A retrospective cohort study of the impact of biologic therapy initiation on medical resource use and costs in patients with moderate to severe psoriasis. Br J Dermatol. 2010;163:807–816.
Rønholt K, Iversen L. Old and new biological therapies for psoriasis. Int J Mol Sci. 2017;18:2297.
Dutta B, Huys I, Vulto AG, Simoens S. Identifying key benefits in European off-patent biologics and biosimilar markets: it is not only about Price! BioDrugs. 2020;34:159–170.
Cohen AD, Vender R, Naldi L, Kalb RE, Torres T, Rajagopalan M, et al. Biosimilars for the treatment of patients with psoriasis: a consensus statement from the biosimilar working Group of the International Psoriasis Council. JAAD Int. 2020;1:224–230.
Carrascosa JM, Jacobs I, Petersel D, Strohal R. Biosimilar drugs for psoriasis: principles, present, and near future. Dermatol Ther (Heidelb). 2018;8:173–194.
International Federation of Psoriasis Associations (IPFA). IFPA position statement: Biosimilars. 13 October 2021 Available from: https://ifpa-pso.com/resources-tools/ifpa-position-statement-on-biosimilars [Accessed September 2023]
Moots R, Azevedo V, Coindreau JL, Dörner T, Mahgoub E, Mysler E, et al. Switching between reference biologics and biosimilars for the treatment of rheumatology, gastroenterology, and dermatology inflammatory conditions: considerations for the clinician. Curr Rheumatol Rep. 2017;19:37.
Nyholm N, Danø A, Schnack H, Colombo GL. The cost-effectiveness of anti-IL17 biologic therapies for moderate-to-severe plaque psoriasis treatment in Italy and Germany: a sequential treatment analysis. Clinicoecon Outcomes Res. 2023;15:607–619.
Puig L. Treatment of moderate to severe plaque psoriasis with biologics: analysis of the additional cost of temporary dose escalation vs switch to another biologic after failure of maintenance therapy. Actas Dermosifiliogr. 2014;105:401–412.
Shahwan KT, Kimball AB. Managing the dose escalation of biologics in an era of cost containment: the need for a rational strategy. Int J Womens Dermatol. 2016;2:151–153.
van der Schoot LS, van den Reek J, Grine L, Schots L, Kievit W, Lambert JLW, et al. Dose reduction of the new generation biologics (IL-17 and IL-23 inhibitors) in psoriasis: study protocol for an international, pragmatic, multicenter, randomized, controlled, non-inferiority study-the BeNeBio study. Trials. 2021;22:707.
Masson Regnault M, Shourick J, Jendoubi F, Tauber M, Paul C. Time to relapse after discontinuing systemic treatment for psoriasis: a systematic review. Am J Clin Dermatol. 2022;23:433–447.
Huang YW, Tsai TF. Remission duration and long-term outcomes in patients with moderate-to-severe psoriasis treated by biologics or tofacitinib in controlled clinical trials: a 15-year single-center experience. Dermatol Ther (Heidelb). 2019;9:553–569.
Beer J, Hadeler E, Calume A, Gitlow H, Nouri K. Teledermatology: current indications and considerations for future use. Arch Dermatol Res. 2021;313:11–15.
Elsner P. Teledermatology in the times of COVID-19 - a systematic review. J Dtsch Dermatol Ges. 2020;18:841–845.
Knol A, van den Akker TW, Damstra RJ, de Haan J. Teledermatology reduces the number of patient referrals to a dermatologist. J Telemed Telecare. 2006;12:75–78.
van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol. 2011;165:1058–1065.
American Telemedicine Association (ATA). Practice guidelines for dermatology. 2016 Available from: https://www.americantelemed.org/resources/practice-guidelines-for-teledermatology/ [Accessed September 2023].
Brinker TJ, Hekler A, von Kalle C, Schadendorf D, Esser S, Berking C, et al. Teledermatology: comparison of store-and-forward versus live interactive video conferencing. J Med Internet Res. 2018;20:e11871.
