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Expert Opin Pharmacother. 2019 Mar;20(4):443-454. doi: 10.1080/14656566.2018.1559819. Epub 2018 Dec 27.

Pharmacotherapeutic strategies for standard treatment-resistant psoriasis.

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a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.
b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.
c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA.


Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy. Currently there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. Areas covered: The authors evaluate the scope of resistance, the reasons it occurs, and provide the reader with strategies for overcoming resistance in both localized and systemic therapies for psoriasis. Expert opinion: 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.


Adherence; anti-drug antibodies; combination therapy; dosage increase; drug switching; pharmacogenetics; treatment resistant

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