The need for long-term continuous therapy in moderate to severe chronic plaque psoriasis

Psoriasis is a chronic inflammatory disease, which may have relevant impact on quality of life, and thus requires treatment over long periods of time (e.g., years) for effective control. Conventional systemic therapies for moderate to severe psoriasis, such as cyclosporin, methotrexate, retinoids and phototherapy have proved effective in suppressing symptoms, but the occurrence or fear of side effects prevent their prolonged use. Therefore, traditional therapy is used intermittently, with early relapse of the disease and not satisfactory long-term disease control. Biological agents represent an important advance in psoriasis treatment and there is general agreement to consider them along-side current conventional therapies for patients candidate to systemic therapy. Two categories of biological agents are currently available for the treatment of psoriasis and/or psoriatic arthritis: T-cell-modulators (efalizumad) and anti-TNF-α agents (etanercept, infliximab, adalimumab). Discontinuation of these drugs is associated with disease relapse in a median time of 60-70 days. Efalizumab provides a good efficacy/safety profile for patients with psoriasis, and is the drug with the longest published trial (>36 months), and is particularly indicated for an effective and safe long-term control of psoriasis.