Latin American Clinical Practice Guidelines on the systemic treatment of psoriasis: SOLAPSO ­ Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society)

This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of healthrelated quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.

Psoriasis Vulgar moderada y severa: opciones terapéuticas (tratamientos convencionales) / Moderate and Severe Psoriasis Vulgaris: therapy options(conventional therapies)

La psoriasis es una enfermedad de filiación inmunológica, frecuente a nivel mundial. En población europea y en EE.UU. reporta una prevalencia del 0,6 al 4%. No hay reportes en Uruguay. La forma clásica de presentación es la vulgar en placas. Si bien en la mayoría de los casos es paucisintomática y las terapias tópicas permiten su control (psoriasis leve), en una proporción importante de casos es capaz de afectar severamente la calidad de vida al generalizarse o asociar afectación de otros órganos, o en casos extremos inclusive llevar a la muerte. El objetivo principal de este artículo es brindar recomendaciones unificadas sobre el tratamiento de la psoriasis vulgar en placas moderada y severa. En esta parte se discuten tratamientos sistémicos ‘convencionales’, priorizando la fototerapia, metotrexato, ciclosporina A y retinoides. Aquí no se incluirán las terapias dirigidas contra blancos moleculares (llamadas ‘terapias biológicas’) que ya constituyen alternativas convencionales en los países desarrollados.

Psoriasis is a common worldwide disease and is considered of immune affiliation. In Europe and the U.S. population reported a prevalence of 0.6 to 4%. There are no reports of Uruguay prevalence. The classic presentation is vulgar plates. Although in most cases the disease is paucisymptomatic and topical therapies allows control (mild psoriasis), in a significant proportion can severely affect quality of life associated with generalized psoriasis or involvement of other organs. Even lead to death. The main objective of this article is to provide unified guidelines on the treatment of chronic plaque psoriasis with moderate to severe presentation. This part discusses systemic ‘conventional’ treatments, giving priority to phototherapy, methotrexate, cyclosporin A and retinoids. The so called ‘Biologic Therapies’ wich are already conventional alternatives in developed countries, will be the subject of Part II of these recommendations.