Management and Costs of Severe Psoriasis: the Role of New Biologics.

It is well accepted that psoriasis has a profound impact on the life of the patient. Moderate-to-severe psoriasis frequently requires phototherapy or aggressive systemic treatment; unfortunately these treatments have major limitations. New biologic treatments are now available that offer distinct safety advantages and possible efficacy advantages over traditional systemic treatments. These biologic drugs are also considerably more expensive than traditional treatments (up to approximately US$30,000 per patient per year). The treatment of psoriasis and other inflammatory skin diseases with biologics could place a significant burden on the healthcare delivery system. In addition to judicious use of biologics, it is the task of the dermatology community to encourage healthcare delivery systems to eliminate the impediments to safe, effective and lower cost treatments such as phototherapy. Appropriate patient selection for biologic therapies is paramount. The goal of therapy for patients with psoriasis is to alleviate suffering in a cost-effective manner for the patient and the healthcare system as a whole. Much has been written on the use of biologic therapies for psoriasis and in this review the authors offer their perspective on the place of biologics in the psoriasis armamentarium.