• Psoriasis is a lifetime autoimmune inflammatory skin disorder that affects 2.8% of the total UK population. All-cause mortality rates remain elevated in psoriasis patients compared with the general population
• Biologic systemic therapies are effective at treating patients with moderate-to-severe psoriasis who have had an inadequate response to conventional systemic therapies
• However, multiple studies have indicated gradual failure of biologics in long-term treatment. Several of these studies have also indicated lower drug survival in biologic experienced patients, compared with those naïve to biologic treatment
• Six biologic systemic agents (adalimumab [ADA], etanercept [ETA], infliximab [INF], ustekinumab [UST], secukinumab [SEC] and ixekizumab [IXE]), as well as dimethyl fumarate (DMF) and the oral PDE-4 inhibitor apremilast (APR), are currently licensed for the treatment of moderate-to-severe psoriasis, although they are only recommended in the UK for severe patients following failure of conventional systemic therapy
• No explicit recommendations exist for the sequencing of biologic systemic therapy options, DMF or APR following treatment failure with conventional systemic therapies, although INF is only recommended for
very severe patients
• Given the effect of psoriasis on patient quality of life and the high cost of these therapies, there is an urgent need for ranking sequencing strategies to maximise cost-effectiveness in the treatment of moderate-to severe psoriasis

Authors: Bungey G, Chang-Douglass S, Leoncini E, Khatiyar J, Davies A, Erickson R

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