TY - JOUR
T1 - From the Medical Board of the National Psoriasis Foundation
T2 - Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis
AU - Choi, Young M.
AU - Debbaneh, Maya
AU - Weinberg, Jeffrey M.
AU - Yamauchi, Paul S.
AU - Van Voorhees, Abby S.
AU - Armstrong, April W.
AU - Siegel, Michael
AU - Wu, Jashin J.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.
AB - Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.
KW - biologic
KW - cyclosporine
KW - immunosuppressant
KW - methotrexate
KW - perioperative
KW - psoriasis
KW - psoriatic arthritis
KW - tumor necrosis factor-alfa inhibitor
UR - http://www.scopus.com/inward/record.url?scp=84995701609&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84995701609&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2016.06.014
DO - 10.1016/j.jaad.2016.06.014
M3 - Review article
AN - SCOPUS:84995701609
VL - 75
SP - 798-805.e7
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 4
ER -