Patients need to secure an effective treatment management plan.
The management plan requires cut-offs to prevent uncontrolled disease, eg. HbA1c 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 .
Patients treatment goal recommend defining individualized patient-treatment goals, as every patient with PsO requires a tailor-made treatment program .
The most often reported patient needs are “get better skin quickly, be healed of all skin defects” .
Needs are higher in younger patients (<65 years) and women have higher expectations and more concern about side-effects than men .
PsO is not only a skin disease, but is on a spectrum, including vascular inflammation  (see Figure 1).
A European Consensus for treatment goals for moderate to severe PsO  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) .
The cut-offs puts treatment failure (ΔPASI 50) as the real treatment goal .
The treatment expectation (ΔPASI 75) is low and there is discussion to raise this to PASI 90  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 It has been proven that the relative and absolute PASI’s align quite well (unpublished data).
van de Kerkhof PC, Reich K, Kavanaugh A, et al. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based multinational assessment of psoriasis and psoriatic arthritis survey. J Eur Acad Dermatol Venereol. 2015;29:2002-10.
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 ]