Speeckaert R, Nikkels A F, Lambert J, Benhadou F, Reynaert V, Ghislain P D, Hillary T, Lambert J L W
Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
Department of Dermatology, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
J Eur Acad Dermatol Venereol. 2025 Mar;39(3):465-475. doi: 10.1111/jdv.20367. Epub 2024 Oct 12.
Targeted biologic drugs and small molecules have transformed the psoriasis treatment landscape in recent years. The Belgian healthcare system, in common with many others across Europe, must balance the burgeoning use of these transformative, yet expensive, drugs with the sustainable use of limited resources. Drawing on recent updates to the EuroGuiDerm and the German S2 psoriasis guidelines, eight Belgian dermatologists experienced in treating patients with psoriasis undertook a quasi-Delphi initiative to provide perspectives on the current opportunities and challenges in psoriasis. This update focuses on responsible ways to rationalize the use of innovative treatments (e.g. biologics and small molecules). Inherently, this required viewpoints on the International Psoriasis Council's new definition of severe psoriasis, defining psoriasis severity and the concept of treating to target. It discusses the appropriateness of using older biologics classes, biosimilars and personalized dosing and lastly, how teledermatology may play a role in providing sustainable, patient-centric psoriasis care. In addition, this manuscript includes the updated Belgian evidence-based treatment advice in psoriasis (BETA-PSO) to reflect recent data and drug approvals. The recommendations reflect the best practices for clinicians when using systemic and biologic therapies to treat patients with psoriasis and offer guidance on how they may prescribe these drugs sustainably and efficiently.
近年来，靶向生物药物和小分子药物改变了银屑病的治疗格局。与欧洲其他许多国家的医疗体系一样，比利时医疗体系必须在合理使用这些变革性但昂贵的药物与可持续利用有限资源之间取得平衡。八位在治疗银屑病患者方面经验丰富的比利时皮肤科医生借鉴了欧洲皮肤病学指南（EuroGuiDerm）和德国S2银屑病指南的最新更新内容，开展了一项准德尔菲倡议，以阐述银屑病当前面临的机遇和挑战。本次更新聚焦于合理使用创新疗法（如生物制剂和小分子药物）的负责任方式。本质上，这需要就国际银屑病理事会对重度银屑病的新定义、银屑病严重程度的界定以及治疗靶点的概念发表观点。它讨论了使用旧有生物制剂类别、生物类似药和个性化给药的适宜性，最后探讨了远程皮肤病学在提供可持续、以患者为中心的银屑病护理中可能发挥的作用。此外，本手稿还纳入了更新后的比利时银屑病循证治疗建议（BETA - PSO），以反映最新数据和药物批准情况。这些建议体现了临床医生在使用全身治疗和生物治疗方法治疗银屑病患者时的最佳实践，并就如何可持续且高效地开具这些药物提供了指导。
