🩹 Methotrexate vs Biologic Step Therapy Simulator

Mild Psoriasis — Topical-First Management

Placeholder: mild BSA cases begin with topical corticosteroids and vitamin D analogs.

• <3%: Typical BSA range (Placeholder mild threshold)
• Topical steroid: First-line agent (Placeholder text)
• BSA rise: Escalation trigger (Placeholder text)
• 8–12 wk: Review interval (Placeholder text)

Topical step overview

Placeholder: topical agents are tried first for limited, mild plaque psoriasis.

Placeholder callout: most mild cases never require systemic therapy.

Methotrexate as the Conventional Systemic Step

Placeholder: moderate-to-severe disease moves to conventional oral systemic therapy.

• 7.5–25 mg/wk: Typical dose (Placeholder dosing)
• 12–16 wk: Response window (Placeholder timeframe)
• ~40%: PASI75 rate (Placeholder benchmark)
• CBC/LFTs: Monitoring (Placeholder labs)

Conventional systemic overview

Placeholder: methotrexate remains the standard first systemic agent tried.

Placeholder callout: response is assessed before considering escalation.

Inadequate Response Triggers Step-Up Review

Placeholder: insufficient improvement after an adequate trial prompts reassessment.

• <PASI50: Failure definition (Placeholder criterion)
• ≥12 wk: Trial duration (Placeholder minimum)
• ~35%: Step-up rate (Placeholder estimate)
• MDT review: Decision point (Placeholder process)

Step-up decision overview

Placeholder: inadequate response is the formal gate to biologic eligibility.

Placeholder callout: documented failure is required before escalation.

Biologic Therapy Escalation

Placeholder: biologic agents are introduced after conventional therapy failure.

• TNFi/IL-17/IL-23: Common classes (Placeholder classes)
• ~70%: PASI90 rate (Placeholder benchmark)
• 4–12 wk: Onset of effect (Placeholder timeframe)
• High: Cost tier (Placeholder note)

Biologic step overview

Placeholder: biologics target specific inflammatory pathways with higher efficacy.

Placeholder callout: biologics are reserved for step-up failures.

Treat-to-Target — Ongoing Reassessment

Placeholder: therapy is continuously matched to measured disease activity.

• PASI90/BSA<1%: Target (Placeholder target)
• Every 3–6 mo: Review cadence (Placeholder interval)
• Possible: De-escalation (Placeholder note)
• Continuous: Loop type (Placeholder note)

Ongoing reassessment overview

Placeholder: the treat-to-target loop repeats indefinitely to sustain control.

Placeholder callout: treatment adjusts up or down as targets are met.