Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists
Identifieur interne : 001622 ( Istex/Corpus ); précédent : 001621; suivant : 001623Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists
Auteurs : C. Paul ; A. Gallini ; A. Maza ; H. Montaudié ; E. Sbidian ; S. Aractingi ; F. Aubin ; H. Bachelez ; B. Cribier ; P. Joly ; D. Jullien ; M. Le Maître ; L. Misery ; M-A Richard ; J-P OrtonneSource :
- Journal of the European Academy of Dermatology and Venereology [ 0926-9959 ] ; 2011-05.
Abstract
Background There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis.
Url:
DOI: 10.1111/j.1468-3083.2011.03990.x
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Maza</name><affiliation><mods:affiliation>Dermatology Department, Paul Sabatier University, Toulouse</mods:affiliation></affiliation></author><author><name sortKey="Montaudie, H" sort="Montaudie, H" uniqKey="Montaudie H" first="H" last="Montaudié">H. Montaudié</name><affiliation><mods:affiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</mods:affiliation></affiliation></author><author><name sortKey="Sbidian, E" sort="Sbidian, E" uniqKey="Sbidian E" first="E" last="Sbidian">E. Sbidian</name><affiliation><mods:affiliation>Dermatology Department, Saint‐Louis Hospital, Paris</mods:affiliation></affiliation></author><author><name sortKey="Aractingi, S" sort="Aractingi, S" uniqKey="Aractingi S" first="S" last="Aractingi">S. 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Richard</name><affiliations><json:string>Dermatology Department, Méditerranée University Aix‐Marseille II, Timone Hospital, France</json:string></affiliations></json:item><json:item><name>J‐P Ortonne</name><affiliations><json:string>Dermatology Department, Nice University, L’Archet II Hospital, Nice</json:string></affiliations></json:item></author><articleId><json:string>JDV3990</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><qualityIndicators><score>5.216</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>127</abstractCharCount><pdfWordCount>7132</pdfWordCount><pdfCharCount>44856</pdfCharCount><pdfPageCount>10</pdfPageCount><abstractWordCount>18</abstractWordCount></qualityIndicators><title>Evidence‐based recommendations on conventional systemic treatments in psoriasis: 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review and expert opinion of a panel of dermatologists</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><p>© 2011 The Authors. JEADV © 2011 European Academy of Dermatology and Venereology</p></availability><date>2011</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists</title><author xml:id="author-1"><persName><forename type="first">C</forename><surname>Paul</surname></persName><note type="correspondence"><p>Correspondence: C Paul. :</p></note><affiliation>Dermatology Department, Paul Sabatier University, Toulouse</affiliation></author><author xml:id="author-2"><persName><forename type="first">A</forename><surname>Gallini</surname></persName><affiliation>Inserm U558, Paul Sabatier University, Toulouse</affiliation></author><author xml:id="author-3"><persName><forename type="first">A</forename><surname>Maza</surname></persName><affiliation>Dermatology Department, Paul Sabatier University, Toulouse</affiliation></author><author xml:id="author-4"><persName><forename type="first">H</forename><surname>Montaudié</surname></persName><affiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</affiliation></author><author xml:id="author-5"><persName><forename type="first">E</forename><surname>Sbidian</surname></persName><affiliation>Dermatology Department, Saint‐Louis Hospital, Paris</affiliation></author><author xml:id="author-6"><persName><forename type="first">S</forename><surname>Aractingi</surname></persName><affiliation>Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris</affiliation></author><author xml:id="author-7"><persName><forename type="first">F</forename><surname>Aubin</surname></persName><affiliation>Dermatology Department, Franche Comté University, University Hospital, Besançon</affiliation></author><author xml:id="author-8"><persName><forename type="first">H</forename><surname>Bachelez</surname></persName><affiliation>Dermatology Department, Saint‐Louis Hospital, Paris</affiliation></author><author xml:id="author-9"><persName><forename type="first">B</forename><surname>Cribier</surname></persName><affiliation>Dermatology Department, Strasbourg</affiliation></author><author xml:id="author-10"><persName><forename type="first">P</forename><surname>Joly</surname></persName><affiliation>Dermatology Department, Rouen University Hospital, University of Rouen</affiliation></author><author xml:id="author-11"><persName><forename type="first">D</forename><surname>Jullien</surname></persName><affiliation>Dermatology Department, Edouard Herriot Hospital, Lyon</affiliation></author><author xml:id="author-12"><persName><forename type="first">M</forename><surname>Le Maître</surname></persName><affiliation>Dermatologist, Caen</affiliation></author><author xml:id="author-13"><persName><forename type="first">L</forename><surname>Misery</surname></persName><affiliation>Dermatology Department, Brest University Hospital, Brest</affiliation></author><author xml:id="author-14"><persName><forename type="first">M‐A</forename><surname>Richard</surname></persName><affiliation>Dermatology Department, Méditerranée University Aix‐Marseille II, Timone Hospital, France</affiliation></author><author xml:id="author-15"><persName><forename type="first">J‐P</forename><surname>Ortonne</surname></persName><affiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</affiliation></author></analytic><monogr><title level="j">Journal of the European Academy of Dermatology and Venereology</title><idno type="pISSN">0926-9959</idno><idno type="eISSN">1468-3083</idno><idno type="DOI">10.1111/(ISSN)1468-3083</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2011-05"></date><biblScope unit="volume">25</biblScope><biblScope unit="supplement">s2</biblScope><biblScope unit="page" from="2">2</biblScope><biblScope unit="page" to="11">11</biblScope></imprint></monogr><idno type="istex">00E8AB5E6607FDD5E47BA162006F9C7D2DAF7EAD</idno><idno type="DOI">10.1111/j.1468-3083.2011.03990.x</idno><idno type="ArticleID">JDV3990</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis.</p></abstract><abstract><p>Objectives The aim of this study was to develop evidence‐based recommendations for the use of traditional systemic treatments in psoriasis in daily clinical practice: methotrexate (MTX), cyclosporin and retinoids.</p></abstract><abstract><p>Methods A scientific committee selected clinically relevant questions concerning the use of MTX, cyclosporin and retinoids in psoriasis. This selection was made using the Delphi method. A systematic literature search was performed in Medline, Embase and the Cochrane Library. The articles selected for analysis were reviewed and the level of evidence was appraised according to the Oxford Levels of Evidence. An Expert consensus meeting took place in June 2010, including 66 dermatologists. Recommendations for daily use of psoriasis systemic treatments were made during interactive workshops where the evidence was reviewed. Agreement among participants and the impact of the recommendations on clinical practice were systematically assessed using voting procedure in a plenary session.</p></abstract><abstract><p>Results A total of 2800 references were identified, among which 122 articles were included in the systematic reviews. Three key recommendations on the use of MTX in psoriasis were formulated, including optimal dosage and route, use of folic acid, risk factors for liver fibrosis and monitoring of hepatotoxicity. The recommendations for cyclosporin in psoriasis focused on the modalities of cyclosporin prescription: dosage, scheme of treatment, optimal duration of treatment, renal toxicity monitoring and evidence for use of cyclosporin in non‐plaque psoriasis (erythrodermic, pustular and ungueal). Recommendations were also made concerning the efficacy and safety of retinoids (mainly acitretin) in plaque and non‐plaque psoriasis.</p></abstract><abstract><p>Conclusions These recommendations for the use of traditional systemic therapies in psoriasis are evidence based and supported by a panel of dermatologists. The next step will be to disseminate these recommendations and assess the agreement of physicians who were not involved in generating the recommendations.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>article-category</head><item><term>ORIGINAL ARTICLE</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-05">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/00E8AB5E6607FDD5E47BA162006F9C7D2DAF7EAD/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1468-3083</doi><issn type="print">0926-9959</issn><issn type="electronic">1468-3083</issn><idGroup><id type="product" value="JDV"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF EUROPEAN ACADEMY DERMATOLOGY VENEREOLOGY">Journal of the European Academy of Dermatology and Venereology</title></titleGroup></publicationMeta><publicationMeta level="part" position="05002"><doi origin="wiley">10.1111/jdv.2011.25.issue-s2</doi><titleGroup><title type="specialIssueTitle">Use of Conventional Systemic Treatments in Psoriasis: Systematic Review and Expert Opinion of a Panel of Dermatologists</title></titleGroup><numberingGroup><numbering type="journalVolume" number="25">25</numbering><numbering type="supplement">s2</numbering></numberingGroup><coverDate startDate="2011-05">May 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="2" status="forIssue"><doi origin="wiley">10.1111/j.1468-3083.2011.03990.x</doi><idGroup><id type="unit" value="JDV3990"></id></idGroup><countGroup><count type="pageTotal" number="10"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title><title type="articleCategory">ORIGINAL ARTICLE</title></titleGroup><copyright>© 2011 The Authors. JEADV © 2011 European Academy of Dermatology and Venereology</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.4.7 mode:FullText" date="2011-03-16"></event><event type="publishedOnlineFinalForm" date="2011-03-09"></event><event type="firstOnline" date="2011-03-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:4.0.1" date="2014-03-19"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-30"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="2">2</numbering><numbering type="pageLast" number="11">11</numbering></numberingGroup><correspondenceTo> C Paul. <b>E‐mail</b>: <email normalForm="paul.c@chu-toulouse.fr">paul.c@chu‐toulouse.fr</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JDV.JDV3990.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received: 26 January 2011; Accepted: 10 February 2011</unparsedEditorialHistory><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="4"></count></countGroup><titleGroup><title type="main">Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists</title><title type="shortAuthors">Paul <i>et al.</i></title><title type="short">Evidence‐based recommendations on conventional systemic treatments</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1" corresponding="yes"><personName><givenNames>C</givenNames><familyName>Paul</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a2"><personName><givenNames>A</givenNames><familyName>Gallini</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>A</givenNames><familyName>Maza</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a3"><personName><givenNames>H</givenNames><familyName>Montaudié</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a4"><personName><givenNames>E</givenNames><familyName>Sbidian</familyName></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a5"><personName><givenNames>S</givenNames><familyName>Aractingi</familyName></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a6"><personName><givenNames>F</givenNames><familyName>Aubin</familyName></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a4"><personName><givenNames>H</givenNames><familyName>Bachelez</familyName></personName></creator><creator creatorRole="author" xml:id="cr9" affiliationRef="#a7"><personName><givenNames>B</givenNames><familyName>Cribier</familyName></personName></creator><creator creatorRole="author" xml:id="cr10" affiliationRef="#a8"><personName><givenNames>P</givenNames><familyName>Joly</familyName></personName></creator><creator creatorRole="author" xml:id="cr11" affiliationRef="#a9"><personName><givenNames>D</givenNames><familyName>Jullien</familyName></personName></creator><creator creatorRole="author" xml:id="cr12" affiliationRef="#a10"><personName><givenNames>M</givenNames><familyName>Le Maître</familyName></personName></creator><creator creatorRole="author" xml:id="cr13" affiliationRef="#a11"><personName><givenNames>L</givenNames><familyName>Misery</familyName></personName></creator><creator creatorRole="author" xml:id="cr14" affiliationRef="#a12"><personName><givenNames>M‐A</givenNames><familyName>Richard</familyName></personName></creator><creator creatorRole="author" xml:id="cr15" affiliationRef="#a3"><personName><givenNames>J‐P</givenNames><familyName>Ortonne</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Dermatology Department, Paul Sabatier University, Toulouse</unparsedAffiliation></affiliation><affiliation xml:id="a2"><unparsedAffiliation>Inserm U558, Paul Sabatier University, Toulouse</unparsedAffiliation></affiliation><affiliation xml:id="a3"><unparsedAffiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</unparsedAffiliation></affiliation><affiliation xml:id="a4"><unparsedAffiliation>Dermatology Department, Saint‐Louis Hospital, Paris</unparsedAffiliation></affiliation><affiliation xml:id="a5"><unparsedAffiliation>Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris</unparsedAffiliation></affiliation><affiliation xml:id="a6"><unparsedAffiliation>Dermatology Department, Franche Comté University, University Hospital, Besançon</unparsedAffiliation></affiliation><affiliation xml:id="a7"><unparsedAffiliation>Dermatology Department, Strasbourg</unparsedAffiliation></affiliation><affiliation xml:id="a8"><unparsedAffiliation>Dermatology Department, Rouen University Hospital, University of Rouen</unparsedAffiliation></affiliation><affiliation xml:id="a9"><unparsedAffiliation>Dermatology Department, Edouard Herriot Hospital, Lyon</unparsedAffiliation></affiliation><affiliation xml:id="a10"><unparsedAffiliation>Dermatologist, Caen</unparsedAffiliation></affiliation><affiliation xml:id="a11"><unparsedAffiliation>Dermatology Department, Brest University Hospital, Brest</unparsedAffiliation></affiliation><affiliation xml:id="a12" countryCode="FR"><unparsedAffiliation>Dermatology Department, Méditerranée University Aix‐Marseille II, Timone Hospital, France</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p><b>Background </b> There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis.</p><p><b>Objectives </b> The aim of this study was to develop evidence‐based recommendations for the use of traditional systemic treatments in psoriasis in daily clinical practice: methotrexate (MTX), cyclosporin and retinoids.</p><p><b>Methods </b> A scientific committee selected clinically relevant questions concerning the use of MTX, cyclosporin and retinoids in psoriasis. This selection was made using the Delphi method. A systematic literature search was performed in Medline, Embase and the Cochrane Library. The articles selected for analysis were reviewed and the level of evidence was appraised according to the Oxford Levels of Evidence. An Expert consensus meeting took place in June 2010, including 66 dermatologists. Recommendations for daily use of psoriasis systemic treatments were made during interactive workshops where the evidence was reviewed. Agreement among participants and the impact of the recommendations on clinical practice were systematically assessed using voting procedure in a plenary session.</p><p><b>Results </b> A total of 2800 references were identified, among which 122 articles were included in the systematic reviews. Three key recommendations on the use of MTX in psoriasis were formulated, including optimal dosage and route, use of folic acid, risk factors for liver fibrosis and monitoring of hepatotoxicity. The recommendations for cyclosporin in psoriasis focused on the modalities of cyclosporin prescription: dosage, scheme of treatment, optimal duration of treatment, renal toxicity monitoring and evidence for use of cyclosporin in non‐plaque psoriasis (erythrodermic, pustular and ungueal). Recommendations were also made concerning the efficacy and safety of retinoids (mainly acitretin) in plaque and non‐plaque psoriasis.</p><p><b>Conclusions </b> These recommendations for the use of traditional systemic therapies in psoriasis are evidence based and supported by a panel of dermatologists. The next step will be to disseminate these recommendations and assess the agreement of physicians who were not involved in generating the recommendations.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Conflicts of interest
All the authors have been paid consultants of Abbott. In addition, C. Paul has been investigator and consultant for Novartis and Wyeth. H. Bachelez has been paid for consulting activities for Centocor, Janssen‐Cilag, Leo Pharma, Novartis, Pfizer and Schering‐Plough. L. Misery has been a paid consultant of Novartis, Janssen‐Cilag, Leo Pharma, Pfizer and Pierre Fabre. MA Richard has consulting activities for Janssen‐Cilag, Novartis, Pfizer and talking for Janssen‐Cilag, Leo Pharma and Pfizer.</p></note><note xml:id="fn2"><p>Funding sources
Abbott France provided financial support for publication but took no further part in the project. The authors have no financial interest in the subject matter or materials discussed in the manuscript.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Evidence‐based recommendations on conventional systemic treatments</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists</title></titleInfo><name type="personal"><namePart type="given">C</namePart><namePart type="family">Paul</namePart><affiliation>Dermatology Department, Paul Sabatier University, Toulouse</affiliation><description>Correspondence: C Paul. : </description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Gallini</namePart><affiliation>Inserm U558, Paul Sabatier University, Toulouse</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Maza</namePart><affiliation>Dermatology Department, Paul Sabatier University, Toulouse</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H</namePart><namePart type="family">Montaudié</namePart><affiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Sbidian</namePart><affiliation>Dermatology Department, Saint‐Louis Hospital, Paris</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Aractingi</namePart><affiliation>Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F</namePart><namePart type="family">Aubin</namePart><affiliation>Dermatology Department, Franche Comté University, University Hospital, Besançon</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H</namePart><namePart type="family">Bachelez</namePart><affiliation>Dermatology Department, Saint‐Louis Hospital, Paris</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B</namePart><namePart type="family">Cribier</namePart><affiliation>Dermatology Department, Strasbourg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Joly</namePart><affiliation>Dermatology Department, Rouen University Hospital, University of Rouen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Jullien</namePart><affiliation>Dermatology Department, Edouard Herriot Hospital, Lyon</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Le Maître</namePart><affiliation>Dermatologist, Caen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L</namePart><namePart type="family">Misery</namePart><affiliation>Dermatology Department, Brest University Hospital, Brest</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M‐A</namePart><namePart type="family">Richard</namePart><affiliation>Dermatology Department, Méditerranée University Aix‐Marseille II, Timone Hospital, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J‐P</namePart><namePart type="family">Ortonne</namePart><affiliation>Dermatology Department, Nice University, L’Archet II Hospital, Nice</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2011-05</dateIssued><edition>Received: 26 January 2011; Accepted: 10 February 2011</edition><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">4</extent></physicalDescription><abstract>Background There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis.</abstract><abstract>Objectives The aim of this study was to develop evidence‐based recommendations for the use of traditional systemic treatments in psoriasis in daily clinical practice: methotrexate (MTX), cyclosporin and retinoids.</abstract><abstract>Methods A scientific committee selected clinically relevant questions concerning the use of MTX, cyclosporin and retinoids in psoriasis. This selection was made using the Delphi method. A systematic literature search was performed in Medline, Embase and the Cochrane Library. The articles selected for analysis were reviewed and the level of evidence was appraised according to the Oxford Levels of Evidence. An Expert consensus meeting took place in June 2010, including 66 dermatologists. Recommendations for daily use of psoriasis systemic treatments were made during interactive workshops where the evidence was reviewed. Agreement among participants and the impact of the recommendations on clinical practice were systematically assessed using voting procedure in a plenary session.</abstract><abstract>Results A total of 2800 references were identified, among which 122 articles were included in the systematic reviews. Three key recommendations on the use of MTX in psoriasis were formulated, including optimal dosage and route, use of folic acid, risk factors for liver fibrosis and monitoring of hepatotoxicity. The recommendations for cyclosporin in psoriasis focused on the modalities of cyclosporin prescription: dosage, scheme of treatment, optimal duration of treatment, renal toxicity monitoring and evidence for use of cyclosporin in non‐plaque psoriasis (erythrodermic, pustular and ungueal). Recommendations were also made concerning the efficacy and safety of retinoids (mainly acitretin) in plaque and non‐plaque psoriasis.</abstract><abstract>Conclusions These recommendations for the use of traditional systemic therapies in psoriasis are evidence based and supported by a panel of dermatologists. The next step will be to disseminate these recommendations and assess the agreement of physicians who were not involved in generating the recommendations.</abstract><relatedItem type="host"><titleInfo><title>Journal of the European Academy of Dermatology and Venereology</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>ORIGINAL ARTICLE</topic></subject><identifier type="ISSN">0926-9959</identifier><identifier type="eISSN">1468-3083</identifier><identifier type="DOI">10.1111/(ISSN)1468-3083</identifier><identifier type="PublisherID">JDV</identifier><part><date>2011</date><detail type="title"><title>Use of Conventional Systemic Treatments in Psoriasis: Systematic Review and Expert Opinion of a Panel of Dermatologists</title></detail><detail type="volume"><caption>vol.</caption><number>25</number></detail><detail type="supplement"><caption>Suppl. no.</caption><number>s2</number></detail><extent unit="pages"><start>2</start><end>11</end><total>10</total></extent></part></relatedItem><identifier type="istex">00E8AB5E6607FDD5E47BA162006F9C7D2DAF7EAD</identifier><identifier type="DOI">10.1111/j.1468-3083.2011.03990.x</identifier><identifier type="ArticleID">JDV3990</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2011 The Authors. 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