Psoriasis
Chronic immune-mediated disease with erythematous scaly plaques predominantly on extensor surfaces, scalp, and nails. Co-occurs with psoriatic arthritis in 20–30%. AEDV 2024 and EuroGuiderm base treatment on severity: mild – topical steroids, vitamin D analogues, calcipotriol; moderate – phototherapy, methotrexate, cyclosporine, apremilast; severe – biologics (anti-TNFα, anti-IL-17, anti-IL-23).
ICD-10 L403 drugs
Also known as: Plaque psoriasis, Psoriasis vulgaris
Drugs used for this condition
- AAdalimumabSecond line · Biologic – tumor necrosis factor alpha (TNFα) inhibitorBiologic for moderate-to-severe plaque psoriasis with PASI over 10, BSA over 10%, or DLQI over 10 per AEDV 2022 and EuroGuiderm. Used after systemic therapies (methotrexate, cyclosporine, acitretin) fail or are intolerable. Starting dose 80 mg subcutaneously, 40 mg one week later, then 40 mg every 2 weeks. Anti-IL-17 and anti-IL-23 biologics (secukinumab, ixekizumab, guselkumab, risankizumab) achieve stronger skin responses in psoriasis and are often preferred.
- AUstekinumabSecond line · Biologic – interleukin-12 and -23 inhibitorSecond-line for moderate-to-severe plaque psoriasis per AEDV 2024 and EuroGuiderm after failure or intolerance of systemic therapies (methotrexate, cyclosporine). Starting dose 45 mg (or 90 mg if over 100 kg) subcutaneously at weeks 0 and 4, then every 12 weeks. Sbidian 2022 meta-analysis: ustekinumab underperforms anti-IL-17 and anti-IL-23 agents (secukinumab, ixekizumab, guselkumab, risankizumab) on PASI 90.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit