A SYSTEMATIC REVIEW OF 5 SYSTEMIC TREATMENTS FOR SEVERE PSORIASIS

We systematically reviewed the evidence concerning the ability of five systemic treatments to induce remission in patients with severe psori asis: ultraviolet B (UVB), photochemotherapy (PUVA), methotrexate (MTX ), retinoids (RET) and cyclosporin A (CYA), An elaborate literature se arch was performed. the validity of studies was assessed, and data wer e analysed, In total, 89, 193, 101, 155 and 127 studies (n = 665) conc erning UVB, PUVA, MTX, RET and CYA were found. The exclusion rate was high, mainly because of concomitant antipsoriatic therapy, outdated do sages or inadequate documentation. No study on MTX could be included. A total of 129 patient series was included in the analysis, reporting on 13,677 patients. Study size-weighted averages of the proportions of patients with clearance and good, moderate and poor response (defined , respectively, as 95-100%, 75-100%, 50-75% and < 50% reduction in the outcome measurements as compared with baseline) were calculated, PUVA therapy was associated with the highest average proportion of patient s with clearance (70%), and the highest proportion of patients with go od response (83%), followed by UVB (68%) and CYA (64%). Incidence of s ide-effects per week was highest in the RET group and lowest in the ph ototherapy groups. This review may provide a basis for the development of guidelines for the treatment of psoriasis, Trials comparing oral m odalities applied according to currently accepted standards should als o be carried out.