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Psoriasis Biologic PBS Access — RACP Adult Medicine MCQ

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EasyDermatologyPsoriasis Biologic PBS AccessRACP Adult Medicine

A 60-year-old man with plaque psoriasis affecting 30% BSA fails topical therapy and phototherapy. He has concurrent metabolic syndrome with BMI 35, diabetes, and hypertension. According to PBS criteria, what systemic therapy class requires failure of conventional agents before access?

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Correct answer: B — Biologic agents (anti-TNF, anti-IL-17, anti-IL-23)

In Australia, PBS-listed biologic agents for moderate-to-severe plaque psoriasis require documented failure of, contraindication to, or intolerance of at least 2 conventional systemic agents (methotrexate, ciclosporin, acitretin). This 'step-through' requirement ensures biologics are reserved for patients who have failed conventional therapy. Once eligible, choice of biologic depends on comorbidities (e.g., avoid IL-17i if concurrent IBD; consider anti-IL-23 for sustained clearance with less frequent dosing).

Reference: eTG – 2025 – Dermatology; PBS – 2025 – Biologic Listings for Psoriasis