Practical Saudi Guidelines on management of moderate-to-severe psoriasis: 2026 update.
The updated Saudi guidelines recommend PASI 90 as the primary treatment goal for psoriasis and advocate for the use of biologic therapies in both adults and children.
Where it sits
this study against the rest of the melanotan i (mt-i) corpusSummary and findings
The paper presents updated clinical practice guidelines for managing moderate-to-severe psoriasis in Saudi Arabia. It emphasizes the use of biologic therapies and recommends the Psoriasis Area and Severity Index (PASI) 90 as the primary treatment goal. The guidelines were developed based on a systematic literature review and address both adult and pediatric patients.
Abstract
<h4>Background</h4>Psoriasis is a chronic, immune-mediated inflammatory skin disease that affects approximately 5.3% of the population in the Kingdom of Saudi Arabia (KSA). Thus, we aim to develop updated evidence-based clinical practice guidelines for the management of adults and pediatric patients with moderate-to-severe plaque psoriasis in the KSA.<h4>Methods</h4>These guidelines followed the "Grading of Recommendations, Assessment, Development, and Evaluation" (GRADE) methodology. We conducted a systematic literature review of PubMed, EMBASE, and the Cochrane Library for high-quality evidence published between 2020 and 2026. The panel developed 31 PICO questions that address key treatment considerations for moderate-to-severe psoriasis.<h4>Results</h4>We established 27 evidence-based recommendations and 4 good-practice statements addressing key aspects of moderate-to-severe psoriasis management. These guidelines strongly recommend adopting the Psoriasis Area and Severity Index (PASI) 90 as the primary treatment goal over PASI 75. For adult patients, the guidelines recommend biologic therapies, including interleukin (IL)-17 inhibitors, IL-23 inhibitors, IL-12/23 inhibitors, and tumor necrosis factor (TNF)-α inhibitors, for better disease control. For pediatric patients, the guidelines recommend early initiation of biologic therapy, with etanercept, secukinumab, ixekizumab, and adalimumab as preferred options.<h4>Conclusion</h4>These Saudi national guidelines offer a comprehensive, evidence-based framework for managing moderate-to-severe psoriasis in adults and pediatric patients.
Background
This paper addresses the management of moderate-to-severe psoriasis, a prevalent chronic skin condition in Saudi Arabia affecting about 5.3% of the population. Previous guidelines may not have incorporated the latest evidence or treatment modalities, making this update significant for practitioners. The study aims to provide a comprehensive framework for treatment based on recent findings.
Methods
The guidelines were developed using the GRADE methodology, following a systematic literature review of databases such as PubMed, EMBASE, and the Cochrane Library for evidence published between 2020 and 2026. A total of 31 PICO questions were formulated to guide the recommendations. The focus was on both adult and pediatric populations.
Results
The guidelines established 27 evidence-based recommendations and 4 good-practice statements for managing moderate-to-severe psoriasis. A strong recommendation was made for adopting PASI 90 as the primary treatment goal. Specific biologic therapies were recommended for adults and pediatric patients.
Interpretation
The recommendations align with current trends in psoriasis management, emphasizing biologic therapies for improved disease control. However, the lack of specific numeric outcomes or clinical trial data limits the ability to assess the clinical significance of the recommendations. The guidelines may be influenced by the available literature but do not provide direct evidence from clinical trials.
Key findings
- Psoriasis affects approximately 5.3% of the population in the Kingdom of Saudi Arabia.
- The guidelines recommend adopting PASI 90 as the primary treatment goal over PASI 75.
- 27 evidence-based recommendations and 4 good-practice statements were established.
Limitations
- Not reported in abstract.
- Guidelines based on systematic review, lacking specific numeric outcomes.
- No direct clinical trial data provided to support recommendations.