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R. Weller, U.S. experience of immunomodulators in the treatment of psoriasis, British Journal of Dermatology, Volume 152, Issue 4, 1 April 2005, Pages 817–818, https://doi.org/10.1111/j.1365-2133.2005.06495.x
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Conflicts of interest: none declared.
Sir, I enjoyed the review by Drs Kormeili, Lowe and Yamauchi1 on the U.S. experience of immunomodulators in psoriasis treatment, but wonder how applicable it is to U.K. practice. The science behind the new biologicals is fascinating, and it is satisfying to see the application of our growing understanding of the pathogenesis of psoriasis applied to develop new treatments. Unfortunately, the efficacy of these new agents does not appear to be any greater than that of currently available agents.
Comparing different agents without head‐to‐head studies is an imperfect science, but I have plotted the data for an at least 75% improvement in the Psoriasis Area and Severity Index at 12 weeks in the phase III studies mentioned in the review by Kormeili et al.2–5 I have then added data drawn from a systematic review by Spuls et al., giving data for oral retinoids, ciclosporin and psoralen plus ultraviolet (UV) A (PUVA), in which the endpoint plotted is a response of 75–100%,6 a recent paper using a representative modern methotrexate regimen,7 and our own Edinburgh data on narrowband UVB. Finally, I have added the gold standard: 3 weeks of inpatient dithranol treatment combined with UVB, where clearance is the endpoint.8 Based on these data (Fig. 1), the efficacy of the biologicals in clearing psoriasis appears no better than currently available treatments.
