Achieving treatment success among patients with moderate to severe psoriasis is a clinically relevant and important issue facing clinicians and patients. Despite advances in systemic therapy, most patients with moderate to severe psoriasis are not satisfied with their treatment. We will discuss strategies to maximize treatment success through the establishment of treatment goals and tailoring of biologic therapy for patients with difficult-to-treat psoriasis. Specifically, we provide evidence-based highlights on the development of biologics, recommendations by psoriasis expert groups on treatment goals, approaches to achieve treatment to defined targets, and therapeutic strategies to customize biologic treatment for nonresponders. The discussion on nonresponders focuses on subpopulations of interest including patients with significant obesity, antidrug antibody formation, personal preferences for medication administration, and treatment nonadherence. We also highlight circumstances where the selection of the systemic medication is driven by safety considerations. As expectation for efficacy and safety increases with continued biologic development for psoriasis, devising real-world treatment strategies to maximize treatment success is critical to improve the overall physical and psychosocial wellbeing of psoriasis patients.
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