Appendix: Information to facilitate discussion of risks and benefits of treatments for people with psoriasis
Data is provided for the proportions of people achieving remission, withdrawing due to adverse events and experiencing specific adverse events (as prioritised by the committee) for interventions that have been recommended in this guideline. Data are based on pooled estimates where possible and from trials with populations and dosing appropriate to the intervention. For full details of the duration of treatment and dosing schedules please refer to the main text of the guideline.
Text is labelled with an asterisk when the committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
For a landscape version of the following table, please refer to the full guideline.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
|
Children with chronic plaque psoriasis of trunk and limbs Note: the committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size |
Intervention:
Placebo:
|
Intervention: Not available Placebo: Not available |
Intervention: Not available Placebo: Not available |
|
Scalp psoriasis |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Not available Placebo: Not available |
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
|
Scalp psoriasis |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Not available Placebo: Not available |
Note: No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
No placebo Active comparator, calcipotriol:
|
Intervention:
Active comparator, calcipotriol:
|
Intervention: Not available Active comparator: Not available |
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
No placebo Active comparator:
|
Intervention:
Active comparator:
|
Intervention: Skin atrophy
Active comparator: Skin atrophy
|
|
Scalp psoriasis Note: No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available. |
Intervention:
Placebo:
|
Intervention:
Placebo:
Note: the committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size |
Intervention: Not available Placebo: Not available |
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
|
Scalp psoriasis |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
Note: No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
Note: No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
No placebo Active comparator, calcipotriol:
|
Intervention:
Active comparator, calcipotriol:
|
Intervention: Not available Active comparator: Not available |
Note: two-third of studies reported home-use of dithranol and in one-third of studies, the setting was unclear.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Chronic plaque psoriasis of trunk and limbs |
Intervention:
No placebo Active comparator, calcipotriol:
|
Intervention:
Active comparator, calcipotriol:
|
Intervention: Not available Active comparator: Not available |
Note: the committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Psoriasis of the face and flexures |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Not available Placebo: Not available |
1) The committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
2) No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available.
| Population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Psoriasis of the flexures |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Skin atrophy
Placebo: Skin atrophy
|
1) The committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
2) No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available.
| Intervention and population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
NBUVB versus PUVA Plaque psoriasis |
Intervention:
No placebo Active comparator, oral PUVA:
|
Intervention:
No placebo Active comparator, oral PUVA:
|
Intervention: Not available Active comparator: Not available |
|
PUVA (oral) Palmoplantar pustulosis Note: No active comparator. An active comparator will only be included if no placebo comparison is available; the standard intervention will be chosen if multiple active comparators are available. |
Intervention:
Placebo, no treatment:
|
Intervention:
Placebo, no treatment:
|
Intervention: Burn
Placebo, no treatment:
|
|
PUVA (cream) Palmoplantar pustulosis |
Intervention:
No placebo Active comparator, NBUVB:
|
Intervention:
No placebo Active comparator, NBUVB:
|
Intervention: Not available Active comparator: Not available |
|
NBUVB plus vitamin D or analogues Plaque psoriasis |
Intervention:
No placebo Active comparator, NBUVB alone:
|
Intervention:
No placebo Active comparator, NBUVB alone:
|
Intervention: Burn
No placebo Active comparator, NBUVB alone: Burn
|
|
BBUVB plus vitamin D or analogues Plaque psoriasis |
Intervention:
No placebo Active comparator, BBUVB alone:
|
Intervention:
No placebo Active comparator, BBUVB alone:
|
Intervention: Not available Active comparator: Not available |
|
Liquor carbonic distillate (equivalent 2.3% coal tar) plus NBUVB Plaque psoriasis |
Intervention:
No placebo Active comparator, NBUVB alone:
|
Intervention:
No placebo Active comparator, NBUVB alone:
|
Intervention: Burn
No placebo Active comparator, NBUVB alone: Burn
|
|
Dithranol plus BBUVB Psoriasis |
Intervention:
No placebo Active comparator, BBUVB alone:
|
Intervention: Not available Active comparator: Not available |
Intervention: Not available Active comparator: Not available |
Abbreviations: BBUVB, broadband UVB; NBUVB, narrowband UVB; PUVA, psoralen plus UVA; UVA, ultraviolet A; UVB, ultraviolet B.
Note: for all the interventions except NBUVB versus PUVA, the committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
| Intervention and population (psoriasis phenotype) | Numbers achieving remissions (clear, nearly clear, or PASI75) | Numbers experiencing withdrawal due to drug toxicity | Numbers experiencing serious or named adverse events |
|---|---|---|---|
|
Methotrexate; incremental dosing (plus folic acid) Chronic plaque psoriasis |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Elevated liver enzymes (>1.5 to 2.5 ULN): 91/1000* Placebo: Elevated liver enzymes (>1.5 to 2.5 ULN): 75/1000* |
|
Ciclosporin Chronic plaque psoriasis |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Hypertension:
Decrease in GFR >15%:
Placebo: Hypertension:
Decrease in GFR >15%:
|
|
Ciclosporin Palmoplantar pustulosis |
Intervention:
Placebo:
|
Intervention: Not available Placebo: Not available |
Intervention: Hypertension:
Placebo: Hypertension
|
|
Acitretin – 25 mg Plaque, pustular and erythrodermic psoriasis* |
Intervention:
Placebo:
|
Intervention:
Placebo:
|
Intervention: Cheilitis:
Hair loss:
Elevated liver enzymes (>ULN):
Elevated cholesterol (>ULN):
Placebo: Cheilitis:
Hair loss:
Elevated liver enzymes (>ULN):
Elevated cholesterol (>ULN):
|
Abbreviations: GFR, glomerular filtration rate; ULN, upper limit of normal.
Note: The committee had very low confidence in the absolute estimates, for example, due to confounding and inadequate sample size.
| Intervention and outcome(s) | Population – psoriasis phenotype | Number experiencing event |
|---|---|---|
|
Psoralen plus ultraviolet A (PUVA; oral) Skin cancer – squamous cell carcinoma (SCC) |
Plaque (84%), guttate (12%) and erythrodermic (4%) psoriasis |
Relative risk compared with the general population:
Absolute increase in risk:
|
|
Narrowband UVB (NBUVB) Skin cancer |
Insufficient data available |
Insufficient data available |
|
Methotrexate Liver fibrosis, bone marrow suppression and pneumonitis |
No long-term data available |
No long-term data available |
|
Ciclosporin Hypertension, renal impairment, gout and hyperuricaemia |
No long-term data available |
No long-term data available |
|
Acitretin Hyperlipidaemia, hepatotoxicity, skeletal adverse events and cheilitis |
No long-term data available |
No long-term data available |