We appreciate the opportunity to provide our comments on ICER’s April 27, 2018 draft evidence
report, “Targeted Immunomodulators for the Treatment of Moderate-to-Severe Plaque Psoriasis:
Effectiveness and Value Condition Update”

Treatment for psoriasis is complicated because of multiple therapeutic options, the systemic
nature of the disease, the variability in its manifestations across a patient population, (i.e., areas
of the skin, types of involvement, and other systemic presentations such as arthritis), and the
diversity of patients’ goals and needs. Thus, successful care for people with psoriasis requires
close collaboration between a patient and their clinical team to determine the best therapeutic
plan for them – including when and if to consider increasing doses or switching medicines, either
within a class or to a medicine in a new class. As ICER’s draft report found “…loss of effect
over time is a very common problem with these drugs. In fact, switching treatment is generally
expected among patients.”i

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