Expert Guidance on Stacking Systemic Therapies for Psoriasis
Dermatologists face challenges in treating psoriasis patients who do not respond fully to systemic therapies. Factors influencing treatment decisions include primary and secondary treatment failures, as well as changes in disease or patient comorbidities. Strategies such as switching therapies within or between classes and stacking treatments are considered based on individual patient responses.
- ▪Dermatologists must decide whether to switch or stack systemic therapies for psoriasis based on patient responses.
- ▪Primary treatment failure occurs when there is no initial response, while secondary failure involves loss of effectiveness after an initial response.
- ▪Factors contributing to treatment failure include immunogenicity, poor adherence, and new disease triggers.
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DENVER — To switch or not to switch? To stack or not to stack? Those are some of the questions dermatologists face when a patient on systemic therapy for psoriasis does not respond fully, when the patient reacts favorably at first but then treatment effectiveness wanes, or when disease or risk factors change over time.The medical board of the National Psoriasis Foundation defines treatment response as achieving 1% or less of affected body surface area at 3 months and at each 6-month maintenance assessment.Boni E. Elewski, MDThat is the goal, but sometimes patients do not respond to the treatment. A primary treatment failure, when a patient has no initial response, “does happen occasionally,” and a secondary failure involves loss of effectiveness after an initial response, Boni E.
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