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Despite the expense of biologic therapies, their use has grown because they are considered to be more effective and less toxic than other therapies. In fact, the toxicity of various agents differs, and their long-term safety is not fully known. A summit meeting on psoriasis education, in which I participated, produced a recommendation that the standard stepwise approach (mandatory failure of systemic therapy before introduction of a biologic agent) be abandoned and that therapeutic selection rest on individual patient characteristics. The N-of-1 trial is a new concept, in which individual patients enter a double-blind trial of two agents, crossing over from one to the other at set times, and the best therapy is then chosen.
To construct hypo…