Update in Psoriasis: Optimizing Combination Topical Therapies to Improve Adherence and Patient Outcomes

The Faculty

	Leon H. Kircik, MD Associate Clinical Professor of Dermatology Icahn School of Medicine at Mount Sinai, New York, New York Associate Clinical Professor of Dermatology Indiana University Medical Center, Indianapolis, Indiana Medical Director Physicians Skin Care, PLLC, Louisville, Kentucky DermResearch, PLLC, Louisville, Kentucky
	David M. Pariser, MD Professor of Dermatology Department of Dermatology Eastern Virginia Medical School Virginia Clinical Research, Inc. Norfolk, Virginia
	Linda F. Stein Gold, MD Director of Dermatology Research Henry Ford Health System Detroit, Michigan

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/Psor19
Inquiries about continuing medical education (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.

Designation Statement

The University of Louisville School of Medicine designates this Enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Joint Provider Accreditation Statement

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 School of Medicine and Global Academy for Medical Education. The University of Louisville School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine (PIM) and Global Academy for Medical Education. Postgraduate Institute for Medicine is jointly accredited by the Accreditation 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 1.5 contact hours. Designated for 0.7 contact hours of pharmacotherapy credit for Advanced Practice Registered Nurses.

Target Audience

This journal supplement is intended for dermatologists, family practitioners, internists, registered nurses, nurse practitioners, physician assistants, and other clinicians who treat patients and practice medical dermatology.

Educational Needs

Most patients with psoriasis will require treatment with topical medications, but patient adherence to topical treatments is low. Adherence may be improved by using more efficacious treatments, considering patient preferences in treatment selection when possible, and simplifying treatment regimens. New formulations using different vehicles to deliver the same active ingredients have been introduced in recent years, with the goal of enhancing penetration, efficacy, and patient acceptance. Commonly used topical agents include corticosteroids, vitamin D analogs, and tazarotene, a retinoid, all of which are available in several vehicles. These medications can be used as monotherapy, but combining topical agents can increase efficacy and sometimes allow for use of lower doses with fewer adverse events. The need to apply multiple medications may complicate adherence, however. Fixed-dose combination treatments, combining 2 active agents in a single vehicle, simplifies the treatment regimen and improves patient acceptance and adherence. Physicians would benefit from education on combination treatment, as well as strategies for improving patient adherence to treatment regimens.

Learning Objectives

At the conclusion of this activity, participants should be better able to:

• Describe the assessment and treatment of patients with psoriasis based on current clinical guidelines and recommendations
• Review the efficacy, safety, and clinical use of current and emerging topical treatments for psoriasis
• Explain strategies to improve clinician-patient communication and the understanding of patient preferences

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, reselling, 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 investi- gational use of a product/device not yet approved.

Leon H. Kircik, MD, Advisory Board: Aclaris, Allergan, Inc., Almirall, Anacor Pharmaceuticals, Biogen-Idec, Celgene Corporation, Cipher, Colbar, Connetics Corporation, EOS, Exeltis, Ferndale Laboratories, Inc., Foamix, Genentech, Inc., Innocutis, Intendis, Isdin, Johnson & Johnson, Nano Bio, OrthoNeutrogena, Promius, Quinnova, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Valeant Pharmaceuticals International, Warner-Chilcott. Consultant: Allergan, Inc., Almirall, Amgen, Inc., Anacor Pharmaceuticals, Cipher, Colbar, CollaGenex, Connetics Corporation, Exeltis, Foamix, Genentech, Inc., Intendis, Isdin, Johnson & Johnson, Laboratory Skin Care Inc., LEO Pharma, Medical International Technologies, Merck, Merz, Novartis AG, OrthoNeutrogena, Promius, PuraCap, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Taro, UCB, Valeant, ZAGE. Grant/Research Support: Acambis, Allergan, Inc., Amgen, Inc., Anacor Pharmaceuticals, Astellas Pharma US, Inc., Asubio, Berlex Laboratories (Bayer HealthCare Pharmaceuticals), Biolife, Biopelle, Boehringer-Ingelheim, Breckenridge Pharma, Celgene, Cellceutix, Centocor, Inc., Coherus, CollaGenex, Combinatrix, Connetics Corporation, Coria, Dermavant, Dermira, Dow Pharmaceutical Sciences, Inc., Dusa, Eli Lilly, Exeltis, Ferndale Laboratories, Inc., Foamix, Genentech, Inc., GlaxoSmithKline, PLC, Health Point, LTD, Idera, Intendis, Johnson & Johnson, LEO, L’Oreal, 3M, Maruho, Medicis Pharmaceutical Corp., Merck, Nano Bio, Novartis AG, Noven Pharmaceuticals, Nucryst Pharmaceuticals Corp, Obagi, Onset, OrthoNeutrogena, PharmaDerm, Pfizer, Promius, QLT, Inc., Quatrix, Quinnova, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, TolerRx, UCB, Valeant, Warner-Chilcott, XenoPort. Speakers Bureau: Abbott Laboratories, Allergan, Inc., Amgen, Inc., Assos Pharma, Astellas Pharma US, Inc., Cipher, CollaGenex, Connetics Corporation, Dermik Laboratories, Embil Pharmaceuticals, Exeltis, Foamix, Genentech, Inc., Innocutis, Innovail, Johnson & Johnson, LEO, L’Oreal, 3M, Onset, OrthoNeutrogena, PediaPharma, PharmaDerm, Serono (Merck Serono International SA), SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Taro, Triax, UCB, Valeant, Warner-Chilcott. Stockholder: Johnson & Johnson.

David M. Pariser, MD, Advisory Board: Pfizer Inc. Consultant: Atacama Therapeutics, Bickel Biotechnology, Biofrontera AG, Celgene Corporation, Dermira, DUSA Pharmaceuticals, Inc., LEO Pharma, US, Novartis Pharmaceuticals Corp., Promius Pharmaceuticals, Regeneron, Sanofi, TDM SurgiTech, Inc., TheraVida, Valeant Pharmaceuticals International. Grant/Research Support: Abbott Laboratories, Amgen, Asana Biosciences, LLC, Bickel Biotechnology, Celgene Corporation, Dermavant Sciences, Eli Lilly and Company, LEO Pharma, US, Merck & Co., Inc., Novartis Pharmaceuticals Corp., Novo Nordisk A/S, Ortho Dermatologics, Peplin Inc., Pfizer Inc., Photocure ASA, Promius Pharmaceuticals, Regeneron, Stiefel, a GSK company, Valeant Pharmaceuticals International.

Linda F. Stein Gold, MD, Consultant: Foamix, Galderma, LEO Pharma, Mayne, Menlo, Pfizer, Sanofi Regeneron, Sol-Gel, Taro, Valeant. Grant/Contracted Research: Foamix, Janssen, LEO, Menlo, Pfizer, Valeant. Speakers Bureau: Galderma, LEO, Mayne, Pfizer, Sanofi Regeneron, Taro, Valeant.
CME/CE Reviewers: Courtney Schadt, MD, Assistant Professor, Division of Dermatology, University of Louisville School of Medicine, has no relevant financial relationships to disclose.

Staff and Advisory Board Disclosures: The University of Louisville CME & PD Advisory Board and office staff have nothing to disclose, with the following Board Member exceptions: Sathya Krishnasamy, MD, Kowa Pharmaceuticals; Ashlee Bergin, MD, Merck Pharmaceuticals; Michael Sowell, MD, Amgen, Impax Pharmaceuticals.

The Postgraduate Institute of Medicine planners and managers have nothing to disclose.

Global Academy for Medical Education staff have nothing to disclose.

This CME/CE supplement was developed from a faculty roundtable. Dr Kircik, Dr Pariser, and Dr Stein Gold acknowledge the editorial assistance of Global Academy for Medical Education and Eileen McCaffrey, MA, medical writer, in the development of this supplement. Neither the editors of Cutis nor the Editorial Advisory Board nor the reporting staff contributed to its content. The ideas and opinions expressed in this supplement are those of the faculty and do not necessarily reflect the views of the supporter, Global Academy for Medical Education, the University of Louisville, Postgraduate Institute for Medicine, or the Publisher.

Copyright © 2019 Global Academy for Medical Education, LLC, and Frontline Medical Communications. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of the Publisher.

Global Academy for Medical Education, LLC, Frontline Medical Communications, The University of Louisville, and Postgraduate Institute for Medicine will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including claims related to the products, drugs, or services mentioned herein.