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Early intervention in psoriasis: Where do we go from here?

Paulo Antônio Oldani Felix1, Ana Luisa Sampaio2, Bruno Leonardo Silva3

  • 1Dermatology Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.

Frontiers in Medicine
|December 19, 2022
PubMed
Summary

Early systemic therapy for psoriasis may reduce long-term complications. Key considerations include defining "early" intervention, patient selection, and success metrics, ideally supported by randomized trials comparing early versus late treatment.

Keywords:
early interventionmethotrexatepsoriasisrisk stratificationsystemic treatmenttherapeutic success

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Area of Science:

  • Dermatology
  • Immunology
  • Clinical Trials

Background:

  • Psoriasis patients face higher risks of comorbidities and complications.
  • Systemic inflammation and immune mediators play a crucial role in psoriasis pathogenesis.
  • Early intervention with systemic therapy is hypothesized to alter disease course and prevent adverse outcomes.

Purpose of the Study:

  • To explore critical issues surrounding the routine implementation of early systemic intervention for psoriasis.
  • To define parameters for successful early intervention strategies.
  • To emphasize the need for high-level evidence, such as randomized trials, to guide clinical practice.

Main Methods:

  • Discussion of key considerations for early intervention implementation.
  • Exploration of defining "early" intervention and appropriate patient subsets (early disease vs. risk-stratified).
  • Emphasis on defining success metrics and the necessity of robust evidence.

Main Results:

  • Several critical issues require careful consideration before routine early intervention.
  • Defining "early" intervention, patient selection criteria, and outcome measures are paramount.
  • High-level evidence from randomized trials is essential for validating early treatment strategies.

Conclusions:

  • Early intervention in psoriasis holds promise for mitigating long-term adverse outcomes.
  • Robust evidence, particularly from randomized controlled trials focusing on long-term endpoints, is needed to establish optimal early treatment protocols.
  • Defining "early" intervention, patient stratification, and success criteria are crucial for effective implementation.