Introduction

Treating patients with psoriasis offers clinicians the opportunity to get back to their medical roots. Because the disease is multifaceted and challenging to manage, clinicians need to look beyond the skin for clues as to how they can best improve and relieve patients’ symptoms and signs.

This supplement represents the perspectives of myself and three of my colleagues, all respected and prolific research dermatologists:

April W. Armstrong, MD, MPH, sets the stage with a primer on the pathophysiology of plaque psoriasis and how drug discovery has led to breakthrough concepts of inflammation and the systemic nature of the disease. In her thorough walkthrough of the therapeutic landscape of treatment for patients with plaque psoriasis, Dr Armstrong discusses the benefits of the major therapeutic classes for plaque psoriasis, from topical agents to biologics.

Kenneth B. Gordon, MD, discusses the controversial concept of treating to target. The question he poses is: Whose target is it? Although traditional measures such as the Psoriasis Area and Severity Index and Physician Global Assessment might appear logical to clinicians, he emphasizes that patients’ individual needs, especially quality-of-life concerns, are equally important and suggests methods that are more patient-centric. In a case vignette, Dr Gordon illustrates the importance of selecting the right starting therapy—one that balances patients’ needs with appropriate efficacy.

New Treatment Paradigms in Psoriasis: Understanding and Incorporating Recent and Emerging Trends

M. Alan Menter, MD, Chair

April W. Armstrong, MD, MPH

Kenneth B. Gordon, MD

Jashin J. Wu, MD

This journal supplement is intended for dermatologists, residents, internists, primary care practitioners, registered nurses, nurse practitioners, and physi- cian assistants who treat patients with psoriasis.

Start CME/CE Activity

Supported by an educational grant from:

Ortho Dermatologics

Activity Information

Original Release Date: March 2018
Expiration Date: April 30, 2019
Estimated Time to Complete Activity: 2.0 hours

Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.The online post-test and evaluation can be accessed at https://tinyurl.com/Psoriasis2018.
Inquiries about CME accreditation may be directed to the University of Louisville Office of Continuing Medical Education & Professional Development (CME & PD) at cmepd@louisville.edu or 502-852-5329.

Faculty

	M. Alan Menter, MD, Chair Chairman, Division of Dermatology Baylor University Medical Center Dallas, Texas
	April W. Armstrong, MD, MPH Associate Professor of Clinical Dermatology Associate Dean for Clinical Research Keck School of Medicine of the University of Southern California Los Angeles, California
	Kenneth B. Gordon, MD Professor and Chair Department of Dermatology Medical College of Wisconsin Milwaukee, Wisconsin
	Jashin J. Wu, MD Director of Dermatology Research Department of Dermatology Kaiser Permanente Los Angeles Medical Center Los Angeles, California

CME/CE Accreditation Statements

Physicians: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Louisville and Global Academy for Medical Education, LLC. The University of Louisville is accredited by the ACCME to provide continuing education for physicians.

The University of Louisville Office of Continuing Medical Education & Professional Development designates this enduring activity for a maximum of 2.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Postgraduate Institute for Medicine and Global Academy for Medical Education.
Postgraduate Institute for Medicine is jointly accredited by the American Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 2.0 contact hours. Designated for 0.8 contact hours of pharmacotherapy credit for Advance Practice Nurses.

Educational Needs

Psoriasis—a chronic, inflammatory, immune-system disease that affects approximately 8 million Americans—is often underdiagnosed. Many clinicians do not approach psoriasis as a systemic, immune-mediated disease with multiple comorbidities, including obesity, metabolic syndrome, cardiovascular disease, and psoriatic arthritis. Even though half of patients with psoriasis complain of arthritic pain, for example, more than two-thirds of dermatologists lack confidence in screening for arthritic comorbidities. Clinicians also frequently fail to screen patients with psoriasis for cardiovascular risk factors, in part because they are unaware that the presence of psoriasis is associated with poor CV outcomes.

Psoriasis is often undertreated. One recent survey found that two-thirds of patients with psoriasis reported being dissatisfied with their treatment; many discontinue treatment due to a lack of efficacy or because of adverse effects. Many clinicians fail to select a therapeutic option that addresses the needs of individual patients, and many neglect the importance of counseling patients adequately about the optimal use of medications or about what to expect from treatment. Complicating the situation is the fact that many clinicians do not adopt a treat-to-target strategy that establishes clear therapeutic goals based on treatment severity (including addressing quality-of-life issues) and that calls for adjusting the regimen as needed.

Clinicians would benefit from education that describes the growing armamentarium of available agents for the treatment of psoriasis, explains the importance of identifying and managing common comorbidities of psoriasis, and presents current data on designing and deploying a treat-to-target strategy, including the use of topical agents and biologics, alone or in combination.

Learning Objectives

By reading and studying this supplement, participants should be better able to:

Explain the etiology and pathophysiology of psoriasis and its common comorbidities
Diagnoseandtreatpatientswithpsoriasisusingtreat-to-targetguidelines
Selectappropriatebiologictherapiesforpatientswithpsoriasis

Disclosure Declarations

Individuals in a position to control the content of this educational activity are required to disclose: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/ device not yet approved.

April W. Armstrong, MD, MPH, Consultant: AbbVie Inc., Amgen Inc., Eli Lilly and Company, Janssen Biotech, Inc., Modernizing Medicine, Novartis Pharmaceuticals Corporation, Regeneron, Sanofi. Speakers Bureau: AbbVie Inc., Eli Lilly and Company, Janssen Biotech, Inc.

Kenneth B. Gordon, MD, Consultant: AbbVie Inc., Amgen Inc., Almirall, S.A., Boehringer Ingelheim, Bristol Myers-Squibb Company, Celgene Corporation, Dermira,Inc.,Eli Lilly and Company, LEO Pharma Inc.,Novartis Pharmaceuticals Corporation, Pfizer Inc., Sun Pharmaceutical Industries Ltd., UCB, Inc. Investigator: AbbVie Inc., Boehringer Ingelheim, Celgene Corporation, Novartis Pharmaceuticals Corporation.

M. Alan Menter, MD, Advisory Board: AbbVie Inc., Afecta Pharmaceuticals, Inc., Amgen Inc., Boehringer Ingelheim, Eli Lilly and Company, Janssen Biotech, Inc., LEO Pharma Inc., Ortho Dermatologics, Promius Pharma, LLC. Consultant: AbbVie Inc., Afecta Pharmaceuticals, Inc., Amgen Inc., Avillion LLP, Boehringer Ingelheim, Eli Lilly and Company, Galderma S.A., Janssen Biotech, Inc., LEO Pharma Inc., Menlo Therapeutics Inc., Novartis Pharmaceuticals Corporation, Ortho Dermatologics, Pfizer Inc., Promius Pharma, LLC. Investigator: AbbVie Inc., Amgen Inc., Boehringer Ingelheim, Celgene Corporation, Dermira, Inc., Eli Lilly and Company, Janssen Biotech, Inc., LEO Pharma Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Regeneron. Speakers Bureau: AbbVie Inc., Amgen Inc., Janssen Biotech, Inc., LEO Pharma Inc., Ortho Dermatologics, Promius Pharma, LLC.

Jashin J. Wu, MD, Contracted Research: AbbVie Inc., Amgen Inc., Eli Lilly and Company, Janssen Biotech, Inc., Novartis Pharmaceuticals Corporation, Regeneron.

University of Louisville CME & PD Advisory Board and Staff Disclosures: The CME & PD Advisory Board and Staff have nothing to disclose.

CME/CE Reviewers: Timothy S. Brown, MD, Clinical Associate Professor, Division of Dermatology, Department of Medicine, University of Louisville School of Medicine. The Postgraduate Institute of Medicine planners and managers Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, MBA, MSN, RN; and Jan Schultz, MSN, RN, CHCP, have nothing to disclose.

Global Academy for Medical Education Staff: Suzanne Bujara; Tristan M. Nelsen, MNM, CMP, HMCC; Sylvia H. Reitman, MBA, DipEd; and Ron Schaumburg have nothing to disclose.

Off-Label/Investigational Use Disclosure

This CME/CE activity discusses the off-label use of certain approved medications as well as data from clinical trials on investigational agents. Such material is identified within the text of the articles.

This continuing medical education (CME/CE) supplement was developed from interviews with the faculty. The Guest Editors acknowledge the editorial assistance of Global Academy for Medical Education and Suzanne Bujara, medical writer, in the development of this supplement. The manuscript was reviewed and approved by the guest editors as well as the Editors of Seminars in Cutaneous Medicine and Surgery. The ideas and opinions expressed in this supplement are those of the Guest Editors and do not necessarily reflect the views of the supporter, Global Academy for Medical Education, University of Louisville, Postgraduate Institute for Medicine, or the publisher.