Conference summaries

PSORIASIS

Treatment goals in psoriasis

Presented by: Ulrich Mrowietz, MD
Psoriasis Center, Dept. of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Germany

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Key points

Psoriasis (PsO) is a chronic, immune-dependent and inflammatory skin disease, affecting men and women equally.
Prevalence estimates suggest the incidence of PsO is approximately 2% of the general population.
The definition of treatment goals for PsO is essential for maintaining a high standard of care.
PsO is associated with a major additional psychological burden.

Introduction

Psoriasis (PsO) is disfiguring with a strong quality of life.
PsO is a stigma and needs to be controlled. This is the real challenge of PsO treatment.

Treatment goals

Patients need to secure an effective treatment management plan.
The management plan requires cut-offs to prevent uncontrolled disease, eg. HbA_1c in diabetes.
The challenge is the definition of “treatment expectations” using appropriate parameters and matching medical needs and patient perspectives, which are not always aligned with the physicians’ perspective [1].
Patients treatment goal recommend defining individualized patient-treatment goals, as every patient with PsO requires a tailor-made treatment program [2].
The most often reported patient needs are “get better skin quickly, be healed of all skin defects” [3].
Needs are higher in younger patients (<65 years) and women have higher expectations and more concern about side-effects than men [3].
PsO is not only a skin disease, but is on a spectrum, including vascular inflammation [4] (see Figure 1).
A European Consensus for treatment goals for moderate to severe PsO [5] tries to include the patients’ perspective with the Dermatology Life Quality Index (DLQI).
DLQI is not a PsO specific document, and it is always with reference to the baseline PASI values (<ΔPASI 50 à modify treatment, >ΔPASI 75 à continue treatment regimen) [6].
The cut-offs puts treatment failure (ΔPASI 50) as the real treatment goal [6].
The treatment expectation (ΔPASI 75) is low and there is discussion to raise this to PASI 90 [7] because the new generation biologic drugs have raised the expectation tremendously, as we know that 80% of the patients can achieve a PASI 90.
However, we also know that only a small proportion of patients will ever benefit from treatment (given availability and costs).
A discussion exists about the difference between absolute and relative PASI for the correct estimation of skin involvement and disease control. It has been proven that the relative and absolute PASI’s align quite well (unpublished data).

Conclusions

Treatment goals are necessary to prevent uncontrolled PsO disease.
Presently, PASI seems the severity score of choice (not because it’s the best but the one most utilized).
Inclusion of patient reported outcomes needs to be linked to physician assessments.
Definition of a true goal is key (eg. PASI <50) after induction therapy.
For long-term maintenance therapy an absolute PASI is superior to a relative PASI reduction (eg. PASI <3 may be a future treatment goal).

Challenges

Treatment goals should not be limited to moderate to severe PsO and should be dermatologically driven definitions of disease severity, also for topical treatments.
Treatment goals should be applicable to all measures to treat/manage PsO, even including other interventions, such as bariatric surgery in obese PsO patients.
Scores other than PASI may be helpful in the future, including the patient perspective.

References

Presenter disclosure(s): [none provided]

Written by: Johanna Chester, BA

Reviewed by: Martina Lambertini, MD

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Welcome to the SPIN 2019 Highlights

Jo Lambert, MD, PhD

With this collection of summaries from selected presentations at SPIN 2019, and interviews with international experts, we hope to share with you some of the highlights of this year’s congress. The international network met … [ Read all ]