Long‐term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach
Authors: De Simone Clara , Dapavo Paolo , Malagoli Piergiorgio , Martella Alessandro , Campanati Anna , Campione Elena , Errichetti Enzo , Franchi Chiara , Gambardella Alessio , Megna Matteo , Osti Federica , Ribero Simone , Zagni Giovanni , Calzavara‐Pinton Piergiacomo , Fabbrocini Gabriella ,   PAM Italian Working Group, Amoruso Giuseppe Fabrizio , Baglieri Francesco , Biamonte Anna Silvia , Bianchelli Tommaso , Bigi Laura , Bortoli Jarno , Brunetti Bruno , Buligan Cinzia , Cagni Elisabetta , Calderoni Ombretta , Calzavara‐Pinton Piergiacomo , Campanati Anna , Caputo Alighiero , Carrera Carlo Giovanni , Carugno Andrea , Chersi Karin , Cicchelli Stefano , De Natale Flora , De Simone Clara , Dapavo Paolo , Di Maria Domenico , Errichetti Enzo , Fabbrocini Gabriella , Ferrari Angelo Salvatore , Fogli Emanuela , Forconi Riccardo , Franchi Chiara , Galeazzi Augusto , Gambardella Alessio , Giovannini Andrea , Giura Maria Teresa , Iuculano Massimo , Lazzaretti Giuseppe , Leporati Claudia , Magnanini Massimiliano , Malagoli Piergiorgio , Marconi Barbara , Martella Alessandro , Maruccia Adriana , Megna Matteo , Miglietta Roberta , Minuti Anna , Mocci Luigi , Modica Sonia , Narcisi Alessandra , Odorici Giulia , Osti Federica , Pazzaglia Massimiliano , Peila Rossana , Pertusi Ginevra , Pezza Michele , Pezzullo Elio , Puccia Nunzio , Raulo Umberto , Ribero Simone , Rossi Mariateresa , Rusignuolo Sergio , Sapienza Giada , Savarese Catello , Scalisi Mariaelena , Strippoli Davide , Stroppiana Elena , Tiberio Rossana , Trischitta Antonino , Tucci Maria Giovanna , Vaira Fabrizio , Verrone Anna , Villa Lucia , Zagni Fabio , Zoccali Andrea 
Published: May 2022

Background

Although long‐term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO‐LONG trial, a fixed‐dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non‐consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long‐term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis.

Methods

A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process.

Results

Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long‐term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation.

Conclusions

The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild‐moderate psoriasis therapeutic approach.