Challenges and solutions in selecting systemic antipsoriatic agents

More than nine treatment options are available in Canada for moderate to severe psoriasis vulgaris. The process of deciding on optimal systemic antipsoriatic therapy for individual patients is dependent on multiple factors, including medical contraindications, the risks and benefits of treatment, and patient values and preferences. This article addresses current challenges faced by both dermatologists and their patients in the process of selecting systemic antipsoriatic therapy. Informed shared decision making is a useful relational model to describe the interaction between dermatologists and psoriasis patients in the selection of best systemic antipsoriatic treatment. There are no systematic reviews inclusive of the spectrum of treatment options for moderate to severe psoriasis, including biologics. Current guidelines of care are of varying quality and provide disparate and conflicting recommendations. Shortcomings in facilitating informed choice include inadequate training, skills, and resources. There is an urgent need for a high-quality systematic review of systemic antipsoriatic agents that includes the biologics. The evidence from such a document can form the basis for rational clinical guidelines and policy and can provide the foundation for educational and counseling tools. Furthermore, to facilitate dialogue and values-based informed choice, the use of decision aids for patients may be useful in selection of the most appropriate therapy.