In 2019, the efficacy and safety of biologic therapy offer most patients with psoriasis the opportunity to achieve safe and complete or nearly complete clearance of skin lesions.1-4 A major obstacle remains across the world, however, in getting access to the best psoriasis medications, owing to high cost and/or lack of adequate health insurance. Indeed, it is commonplace for insurance companies and national regulatory authorities to control use of biologics to reduce overall costs to health care. More specifically, patients with psoriasis often have to experience treatment failure with cheaper, less effective, and less safe nonbiologic drugs prior to gaining access to biologics.5 The use of older biologics, such as adalimumab and ustekinumab, is often required (because of their lower cost in some settings) prior to using newer biologics that target interleukin (IL)-17A or IL-23,5 which are generally more effective.1-4 Thus, the cost of health care often dictates therapeutic choices, rather than the physician and/or patient choosing what is best for the patient.
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Blauvelt A. Predicting Clinical Responses to Ustekinumab: Progress Toward a Future of Personalized Medicine. JAMA Dermatol. 2019;155(11):1227–1228. doi:10.1001/jamadermatol.2019.2587
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