Treatment of Moderate-to-Severe Plaque Psoriasis with Concomitant Multiple Sclerosis

When a patient has both moderate-to-severe plaque psoriasis and multiple sclerosis, the selection of systemic therapy requires careful consideration. The neurological comorbidity rules out certain biologic classes that would otherwise be considered standard options.

Clinical Scenario

This protocol is specific to patients with moderate-to-severe plaque psoriasis who carry a concurrent diagnosis of multiple sclerosis. The presence of multiple sclerosis directly determines which treatment pathways are appropriate and which must be avoided.

Treatment Approach

Patients with concomitant multiple sclerosis may benefit from ustekinumab therapy. TNF-α inhibitors are specifically excluded from consideration in this setting due to the pre-existing multiple sclerosis.

The full regimen, including clinical criteria and complete sequencing, is available in the structured protocol below.

Clinical Goals

The primary treatment target is a 75% improvement in the Psoriasis Area Severity Index (PASI 75). A definitive assessment of response — positive or negative — is best made after 12 weeks of continuous therapy.

Instant Access to Structured Evidence-Based Regimens

References

Patients with a history of concomitant multiple sclerosis and/or IBD might benefit from ustekinumab therapy.
For TNF-α inhibitor therapy, significant New York class III or IV CHF or pre-existing multiple sclerosis.
Definitive response (positive or negative) to treatment with ustekinumab is best ascertained after 12 weeks of continuous therapy.

DOI: 10.1016/j.jaad.2018.11.057

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