A flexible framework for the use of biological agents in psoriatic disorders (PD) was compiled by a group of 5 Italian dermatologists and 6 rheumatologists. The guidelines were based on published studies and clinical opinion. The three key tumor necrosis factor-alpha (TNF-alpha) inhibitors were adalimumab, etanercept and infliximab and were all deemed effective in PD. They were recommended for use in moderate-severe disease refractory to systemic therapy with nonbiological agents. Data from phase II-III randomized controlled trials for other biological agents were also discussed, including golimumab, ustekinumab, ABR-874 and alefacept. Definitions of moderate-severe PD based on the Psoriasis Area and Severity Index, body surface area affected and the Dermatology Life Quality Index ...