Priority 12 from the Psoriasis PSP

UNCERTAINTY: What are the long-term benefits and risks of oral and biological psoriasis treatments? (JLA PSP Priority 12)
Overall ranking 12
JLA question ID 0072/12
Explanatory note Not available for this PSP

Ahn, 2015 Evidence for TB testing as part of the pre-biologics screening.  Study limited by lack of standardised CTs evaluating utility of screening / monitoring.  Clinicians advised to use their judgement.  Further evidence / investigation required. 

Farahnik, 2017 Review of oral BOTANICAL therapy – not standard therapy.  Minimal literature (quality and quantity).  More evidence required. 

Marra, 2016 Some data on risk of herpes zoster in patients on biologics, DMARDs and corticosteroids.  Multiple indications – not limited to psoriasis.  Post-marketing surveillance (especially of newer agents) is required. 

No, 2018 Drug survival data presented.  Limited data.  Heterogeneity of included studies.  New treatments now available (sine paper published).  Evidence for long-term efficacy, utility and tolerability of (some) commonly prescribed biologics.  Further evidence required. 

Peleva, 2018 8 studies met the inclusion criteria – investigating the risk of cancer in patients on biological therapy.  Analysis limited due to differences in studies identified.  Recommendation made for further enquiry / collection of pharmacovigilance data to determine risk specifically attributable to biological therapy. 

Snast, 2017 Retrospective cohort study.  Some evidence for low risk of Hep C reactivation but considerable risk for chronic Hep B (needing antiviral prophylaxis).  Heterogeneous studies evaluated.  Further evaluation and studies (especially large-scale prospective trials) needed. 

Yiu, 2016 No association between biologic therapies and serious infections detected.  Further observational studies are needed to inform the uncertainty about this risk in the real world.  No paper download.

Health Research Classification System category Skin
Extra information provided by this PSP
Original uncertainty examples Are biologic's safe in the long term?
Submitted by 63 uncertainties were submitted around this question
PSP information
PSP unique ID 0072
PSP name Psoriasis
Total number of uncertainties identified by this PSP. 55  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 17 September 2018