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Role of the pharmacist

Adherence and patient education

Pharmacists are well placed to understand the experience of patients with psoriasis and to use their expert knowledge to promote effective and optimal treatment

Andrew Pothecary MSc MRPharmS Specialist Pharmacist, Biologics UK National Health Service

The continued development of new agents for the treatment of plaque psoriasis is undoubtedly of value, making it possible to target an increasing number of cytokines and pathways within the inflammatory cascade. Following the failure of topical therapies (or a decision not to use them), patients may be treated with phototherapy and/or one or more oral therapies including methotrexate, ciclosporin or acitretin. If these treatments are ineffective, biologic therapy will be the next step. Biologic therapies that target tumour necrosis factor (TNF) have been available for approximately the past ten years; biologics that target the p40 subunit of interleukin (IL)-12 and -23 for approximately the past five years; while a biologic that targets IL-17A – now known to be one of the principal pro- inflammatory cytokines in diseases such as psoriasis and psoriatic arthritis – has recently become available for use in moderate to severe psoriasis. Of these three mechanisms of action, anti-TNF is the most remote and anti-IL-17A is the most proximate to the immunological elements driving the disease


pathophysiology. In addition, a novel oral agent targeting phosphodiesterase 4 has also recently become available. Although the availability of these agents can be expected to lead to an improvement in patient outcomes by providing more options for treating patients. there is – as with the

introduction of any new treatments – a need to manage their introduction and use to ensure the effective use of limited healthcare resources.

Medicines optimisation

Pharmacists working in both primary and secondary care settings are ideally placed to use their skills and knowledge to support dermatologists and other clinicians in the introduction and appropriate use of these new agents. Applying the principles of medicines optimisation (MO) to the treatment of plaque psoriasis can help to improve patient outcomes while also making the most effective use of healthcare resources.

Key principles

There are four key principles of MO:1 ● Understanding the patient’s experience

● Evidence-based choice of medicines ● Ensure medicines use is as safe as possible

● Make MO part of routine practice.

Understanding the patient’s experience A large, multinational survey of psoriasis and psoriatic arthritis patients in North America and Europe found that the most troublesome symptoms of psoriasis were itching, scales and flaking. Forty-five per cent of patients had not seen a physician within the previous 12 months and more than 80% of patients with more than four palms’ body surface area affected by psoriasis were receiving either no treatment or topical therapy only.2

In the

UK, the first port of call for psoriasis treatment may be the general practitioner (GP), and approximately 18% of patients diagnosed with psoriasis in primary care will be referred to a specialist, with the

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