Co-provided by Curatio CME Institute and EduPro Resources LLC

Support for this activity has been provided through an educational donation from Amgen and Wyeth, Centocor, and Genentech.

Activity Overview
Although biologic agents for psoriasis treatment have been available for several years, dermatology health care professionals are still uncomfortable with their use in some situations. Clinical issues raising uncertainty include when and how to transition a patient to biologic therapy, how to manage a patient who is not achieving a response to a biologic therapy, and how to employ combination therapy with biologics. Clinicians are also in need of guidance on proper monitoring of patients receiving biologic agents. Safety considerations associated with the use of biologic agents are especially important for long-term treatment of patients with moderate to severe psoriasis. This activity will focus on the practical applications of the available data on biologic agents for the treatment of psoriasis and present strategies for managing clinically challenging patients in a case-based format.

Target Audience
This activity has been designed to meet the educational needs of dermatologists, dermatology residents and fellows, dermatology nurses, nurse practitioners, and physician assistants who manage patients with moderate to severe psoriasis.

Learning Objectives
Upon completion of this activity, participants should be able to:

• Identify patients who may be candidates for transitioning to biologic therapy
• Apply patient-based characteristics in determining treatment choices
• Formulate treatment strategies for managing loss of efficacy with biologic agents, including transition to other agents and implementation of combination therapy
• Implement recommended monitoring for patients receiving biologic therapy
• Recognize updated long-term safety data for biologic agents used in treating psoriasis

Accreditation Statements
Physician
Curatio CME Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Curatio CME Institute designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurse
EduPro Resources LLC is an approved provider of continuing nursing education by NJSNA, an accredited approver by the American Nurses Credentialing Center’s (ANCC’s) Commission on Accreditation, Provider Number P208-8/08-11.

EduPro is also an approved provider by the California Board of Registered Nursing (CBRN), Provider Number CEP-14387.

This activity is approved for 1 nursing contact hour.

Accreditation refers to educational content only and does not imply ANCC, NJSNA, CBRN, or EduPro endorsement of any commercial product.

Physician Assistant
This program has been reviewed and is approved for a maximum of one hour of AAPA Category I CME credit by the Physician Assistant Review Panel. Approval is valid for one year from the issue date of June 22, 2009. Participants may submit the self-assessment at any time during that period. This program was planned in accordance with AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.

Nurse Practitioner
This program is approved for 1 contact hour(s) of continuing education by the American Academy of Nurse Practitioners. Program ID 0904171.

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period of June 2009 to June 30, 2010, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form. Participants who successfully complete the activity can download a CME/CE certificate from this site.

Media
A downloadable/printed newsletter and the Internet were selected as the instructional formats to accommodate the learning preferences of a significant portion of our target audience.

This newsletter may include discussions of the unlabeled or investigational use of commercial products and/or the use of unapproved investigational agents.

Disclosure
In accordance with the ACCME Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

Jeffrey J. Crowley, MD, has disclosed the following relevant financial relationships:

Consultant	Abbott, Genentech
Grants/Research/Honoraria/Speakers' Bureau	Abbott, Amgen, Genentech

Neil J. Korman, MD, PhD, has disclosed the following relevant financial relationships:

Grants/Research	Abbott, Amgen, Centocor
Speakers' Bureau	Abbott, Astellas, Centocor

Curatio CME Institute

Barbara Bekiesz, Editor, has disclosed no relevant financial relationships.
Shari J. Dermer, PhD, Medical Director, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, has disclosed no relevant financial relationships.

EduPro Resources LLC

Dorothy Caputo, MA, APRN, BC-ADM, CDE, Nurse Planner, has disclosed no relevant financial relationships.

Disclaimer
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.

Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, American Academy of Physician Assistants (AAPA), EduPro Resources LLC, the American Academy of Nurse Practitioners, Amgen, Wyeth, Centocor, and Genentech do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, American Academy of Physicians Assistants, EduPro Resources LLC, the American Academy of Nurse Practitioners, Amgen, Wyeth, Centocor, and Genentech. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/ Investigational Use
ABT-874	N/A	N/A	Treatment of adult patients (18 years or older) with moderate to severe plaque psoriasis
Adalimumab	Humira®	Treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate	Weekly administration Combination therapy with systemic agents (acitretin, methotrexate) Combination therapy with UVB phototherapy
Efalizumab*	Raptiva®	Treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy	Combination therapy with cyclosporine
Etanercept	Enbrel®	Treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy	Combination therapy with systemic agents (acitretin and methotrexate) Combination therapy with UVB phototherapy
Infliximab	Remicade®	Treatment of adult patients with chronic severe plaque psoriasis who are candidates for systemic therapy and when other systemic therapies are medically less appropriate	Combination therapy with methotrexate
Ustekinumab	N/A	N/A	Treatment of adult patients (18 years or older) with moderate to severe plaque psoriasis

*This product will no longer be available in the U.S. as of June 2009.

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