Strategies for Managing Complex Psoriasis Cases

Release date: January 2010
Expiration date: January 31, 2011
Estimated time to complete activity: 30 minutes

Sponsored by Curatio CME Institute

Support for this activity has been provided through educational grants from Amgen and Genentech.

Activity Overview
To accurately measure treatment efficacy, clinical trials of psoriasis therapies enroll homogeneous patient populations. Outside of clinical trials, psoriasis patients exhibit considerable variability in their overall health status. Psoriasis patients who have comorbid conditions, such as HIV or multiple sclerosis, represent a treatment challenge for dermatologists. In this Expert Practice, Dr. Neil Korman from the Murdough Family Center for Psoriasis at University Hospitals Case Medical Center discusses how to approach the treatment of psoriasis patients with concomitant diseases or preexisting medical conditions. Dr. Korman also addresses another treatment challenge, the management of patients who have recalcitrant psoriasis. Treatment strategies for patients who do not respond satisfactorily to anti–tumor necrosis factor (TNF) agents will also be addressed.

Target Audience
This activity has been designed to meet the educational needs of dermatologists, dermatology residents and fellows, dermatology nurses, nurse practitioners, physician assistants, and other health care professionals involved in the care of patients with moderate to severe psoriasis.

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

Describe evidence-based recommendations for the treatment of moderate to severe psoriasis, including the use of traditional and biologic systemic agents
Develop treatment strategies for difficult-to-manage cases of psoriasis, taking into consideration all available therapeutic options
Formulate a practical plan for managing moderate to severe psoriasis, taking into consideration complex patient characteristics

Faculty
Neil J. Korman, MD, PhD
Professor of Dermatology
Clinical Director, Murdough Family Center for Psoriasis
University Hospitals Case Medical Center
Cleveland, Ohio

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

Credit Designation
Curatio CME Institute designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period January 2010 to January 31, 2011, 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.

Media
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.

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:

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

Consultant/Speaker	Abbott, Astellas, Centocor Ortho Biotech, Genentech
Investigator	Amgen
Fellowship Program	Centocor Ortho Biotech

Curatio CME Institute
Shari J. Dermer, PhD, Medical Director, has disclosed no relevant financial relationships.
Thomas Finnegan, PhD, Medical Writer, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, 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, Amgen, 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, Amgen, or 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
Adalimumab	Humira	Reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderate to severe rheumatoid arthritis; reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 4 years of age or older; reducing the signs and symptoms of active psoriatic arthritis, inhibiting the progression of structural damage, and improving physical function; reducing signs and symptoms in patients with ankylosing spondylitis; reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderate to severe Crohn’s disease who have had an inadequate response to conventional therapy. Reducing signs and symptoms and inducing clinical remission in these patients if they have lost response to or are intolerant to infliximab; treatment of adult patients with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate	For the treatment of psoriasis in combination with other systemic psoriasis therapies (acitretin, methotrexate, cyclosporine) or ultraviolet light therapy
Cyclosporine	Neoral	Prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants; chronic rejection in patients previously treated with other immunosuppressive agents; severe active rheumatoid arthritis that does not adequately respond to methotrexate; severe and recalcitrant psoriasis that is not responsive to at least one systemic therapy or in patients where other systemic therapies are contraindicated or intolerable	Treatment of psoriatic arthritis
Enfuvixtide	Fuzeon	Use in combination with other retroviral agents for the treatment of HIV-1 infection in treatment experienced patients with HIV-1 replication despite ongoing antiretroviral therapy	In combination with stavudine+tenofovir for the treatment of psoriasis with HIV
Etanercept	Enbrel	Reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis. Can be initiated in combination with methotrexate or used alone; reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients ages 2 and older; reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in patients with psoriatic arthritis. Can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone; reducing signs and symptoms in patients with active ankylosing spondylitis; treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy	For the treatment of psoriasis in combination with other systemic psoriasis therapies (acitretin, methotrexate, cyclosporine) or ultraviolet light therapy
Hydroxyurea	Droxia Hydrea	Reduction of the frequency of painful crises and to reduce the need for blood transfusions in adult patients with sickle cell anemia with recurrent moderate to severe painful crises (generally at least 3 during the last 12 months); tumor response has been demonstrated in melanoma, resistant chronic myelocytic leukemia, and recurrent, metastatic, or inoperable carcinoma of the ovary; used concomitantly with irradiation therapy is intended for use in the local control of primary squamous cell (epidermoid) carcinomas of the head and neck, excluding the lip	Treatment of psoriasis
Infliximab	Remicade	In combination with methotrexate for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis; reducing signs and symptoms and inducing and maintaining clinical remission in adult and pediatric patients with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy. Also used to reduce the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in adult patients with fistulizing Crohn’s disease; reducing signs and symptoms in patients with active ankylosing spondylitis; reducing signs and symptoms of active arthritis, inhibiting the progression of structural damage, and improving physical function in patients with psoriatic arthritis; treatment of adult patients with chronic severe plaque psoriasis who are candidates for systemic therapy and when other systemic therapies are medically less appropriate. Infliximab should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician; reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.	For the treatment of psoriasis in combination with other systemic psoriasis therapies (acitretin, methotrexate, cyclosporine) or ultraviolet light therapy
Stavudine	Zerir	In combination with other antiretroviral agents for the treatment of HIV-1 infection	In combination with tenofovir + enfuvirtide for the treatment of psoriasis in patients with HIV
Tenofovir	Viread	In combination with other antiretroviral agents for the treatment of HIV-1 infection in adults; for the treatment of chronic hepatitis b in adults	In combination with enfuvirtide + stavudine for the treatment of psoriasis in patients with HIV
Zidovudine	Retrovir	In combination with other retroviral agent for the treatment of HIV infection	For the treatment of psoriasis in patients with HIV

Hardware/Software Requirements

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Strategies for Managing Complex Psoriasis Cases

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