Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy, according to a recent investigation. Currently, there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. In this review, researchers evaluate the scope of resistance, the reasons it occurs, and provide strategies for overcoming resistance in both localized and systemic therapies for psoriasis. Key findings include:
- Refractory psoriasis involves modifiable and non-modifiable factors that warrant different approaches to maximize clinical response.
- Treatment-resistance to topical therapies may be due to poor adherence.
- Improving adherence involves incorporating patients’ treatment preferences, improving the physician-patient relationship, and simplifying treatment regimens.
- Treatment-resistance to systemic therapies can be due to non-adherence but can also be due to ineffective dosing, development of anti-drug antibodies, and severe disease that necessitates multiple drugs.
- After addressing non-adherence, strategies to maximize systemic therapies include increasing the dosage, combining treatments, drug switching, and incorporating pharmacogenetics.
Heath MS, Kolli SS, Dowling JR, Cline A, Feldman SR. Pharmacotherapeutic strategies for standard treatment-resistant psoriasis. [Published online ahead of print December 27, 2018]. Exp Opin Pharmacother. doi:10.1080/14656566.2018.1559819.