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Optimising psoriasis care pathway

Abou Atwan, Ausama 2018. Optimising psoriasis care pathway. MD Thesis, Cardiff University.
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Abstract

Optimising the psoriasis care pathway is a multifaceted process that requires input from all healthcare professionals involved in psoriasis patient care. At the primary healthcare level GPs should be more aware of the impact of psoriasis on patients’ lives and use a validated quality of life instrument to measure this impact and ideally to improve the triage of psoriasis referrals to secondary care. One of the studies presented in this thesis shows a potential benefit of utilizing the Dermatology Life Quality Index (DLQI) as a triage tool to identify those individuals experiencing the greatest impact on their quality of life. Systemic therapies for psoriasis should be selected on a case by case basis according to guidelines, patients’ comorbidities and their personal preferences. It is important that patients are fully aware of the available evidence to enable them to make informed decisions. Fumarates are one of the recognised systemic therapies for psoriasis. The Cochrane systemic review presented in this thesis demonstrates its superiority over placebo and possibly similar efficacy to methotrexate; however these findings were based on low-quality evidence. Following the Cochrane review publication, dimethylfumarate was licensed by the European Medicines Agency (EMA) based on new trial evidence and approved by the National Institute for Health and Care Excellence (NICE) as a third line systemic therapy for moderate-to-severe psoriasis. There is growing evidence that continued improvement on fumarates occurs after the usual 12 – 16 week endpoints commonly used in psoriasis trials. Therefore, long-term randomised clinical trials are needed to measure their true effect and safety in direct headto- head comparisons with other systemic treatments. Inclusion of fumarates in pharmacovigilance databases will be important to assess rare, delayed adverse effects such as progressive multifocal leukoencephalopathy.

Item Type: Thesis (MD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 2 April 2019
Last Modified: 02 Apr 2019 09:33
URI: http://orca.cf.ac.uk/id/eprint/121251

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