Biologic therapy for psoriasis: telephone triage

The past 15 years have been a time of remarkable achievement in the treatment of psoriasis. New topical medications with efficacy and safety have been introduced. At the same time, there has been resurgence in the use of traditional agents such as methotrexate and cyclosporine. An enlightened understanding of psoriasis as an immune-mediated disease has led to the development of unique injectable medications called biologics. All of these developments have occurred in part as we have gained a better understanding of the powerful impact that psoriasis has on patients. The biologics represent a new and exciting class of medications for treating psoriasis. Their novelty is reflected by both excitement and uncertainty. Efficacy rates of the biologics in treating psoriasis are unparalleled and safety data over the short term is promising. However, long-term safety data does not exist. Furthermore, as with any new class of medication, specifically an injectable preparation costing approximately $18,000 to $30,000 annually, concern on the part of patients is expected. Despite any uncertainty, the biologics are drastically altering the arena of psoriasis care. Clinicians have an entirely new class of medications to recommend to patients who have either failed or are not eligible for traditional agents. At the same time, due to the expense of these agents, the relationship between the patient, clinician, and insurer is changing. Certainly the introduction of biologics has created a need for educating clinic staff regarding these therapies. There are barriers to the effective and safe use of the biologics; often, these barriers lie at the level of the patient and depend on his comfort level and understanding of the treatment. This being said, it is the charge of the dermatology community, especially those on the front lines such as nurses, to lead efforts in patient education to ensure the best care for those suffering from psoriasis.