Journal of Clinical and Aesthetic Dermatology

Psoriasis and Cutaneous Supplement 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/729153

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S 6 S U P P L E M E N T T O T H E J O U R N A L O F C L I N I C A L A N D A E S T H E T I C D E R M AT O L O G Y [ S E P T E M B E R 2 0 1 6 • V O L U M E 9 • N U M B E R 9 ] with chronic moderate-to-severe plaque psoriasis being currently treated with biologic agents correlates with the mean percent reduction in PASI score (R2=0.8055). 1 0 A reduction in PASI of at least 75 percent can result in significant improvements in quality of life for patients. 10 When the Psoriasis Symptom Diary (PSD) was correlated with data from two double-blind, placebo-controlled, Phase 3 studies in patients with moderate-to-severe plaque psoriasis treated with secukinumab (n=820), items on the PSD achieved high intraclass coefficients (>0.90) and were considered moderate-to-strong in magnitude (0.41–0.73) by Week 12 of the study. This suggests that the PSD is a valid tool that can help in reaching appropriate treatment choices in these patients. 11 Sex-specific differences in quality of life of patients with moderate-to-severe plaque psoriasis were evaluated using data from the Phase 3 REVEAL study 12 of adalimumab. 13 Women had significantly worse mean scores than men for DLQI, mental component score (MCS), and physical component score (PCS) than men (MCS and PCS are part of the SF-36 metric). Women had significantly higher scores in presenteeism (20.5% vs. 16.6%, p=0.0229), in total work productivity impairment (21.8% vs. 17.0%, p=0.0079, and total activity impairment (32.3% vs. 24.0%, p<0.0001). Absenteeism was similar in women and men (4.9% vs. 3.1%, p=0.0980). This suggests that female patients with moderate-to-severe psoriasis suffered more in their health-related quality of life and work productivity compared to male patients. 13 DLQI scores are associated with the body region(s) affected by psoriasis. There was a clear impact on patients with head/neck PASI 100 response compared to similar patients with PASI <100 in terms of the percentage of patients who had a DLQI score of 0 or 1 (this corresponds with a lack of or very little effect of psoriasis on the patient's health-related quality of life). For other areas of the body PASI >75 versus PASI <75 also impacted those patients who scored DLQI 0 or 1. This suggests that head/neck clearance might disproportionately impact patient-reported satisfaction with treatment and quality of life (Navarini AA, et al. EADV 2012—Annual Congress of the European Academy of Dermatology and Venereology, Prague, Czech Republic poster 949). These findings were supported by a study of REVEAL patients (n=15,280 assessments in 4,988 patients), which found that more severe skin lesions on the head or upper extremity had a disproportionately large impact on the DLQI compared to BSA, particularly for younger patients (both male and female). 14 Thus, the location of skin symptoms can exert a significant impact on the health-related quality of life of psoriasis patients. In conclusion, the use of psoriasis-specific PROs may reflect patient status better than the DLQI or other objective instruments. PROs are designed to capture symptoms associated with psoriasis that are important to the patient and are also valuable in measuring treatment efficacy. The Psoriasis Symptom Inventory (PSI) is an eight-item instrument that allows patients to self-report symptom severity; the PSI has demonstrated good reliability and validity in testing. 9,15 The PSI assesses symptoms in the last 24 hours. Patients rate each symptom on a five-point verbal scale ranging from "not at all" to "very severe." Patients are asked about itchiness, redness, scaling, burning, stinging, cracking, flaking, and TABLE 1. Patient-reported outcomes for patient perception of psoriasis 6–9 INSTRUMENT DISEASE FACTORS ASSESSED RECALL PERIOD COMMENTS DLQI Symptoms Psychosocial impact Physical impairment Treatment 1 week Does not assess • Certain symptoms relevant to psoriasis • Symptom severity PSA scale Symptom frequency and burden 2 weeks Does not assess • Clinical severity of symptoms • Psychosocial impact PSI Symptom frequency and severity 1 day or 1 week Does not assess • Psychosocial impact • Has been used in clinical trials Psoriasis symptom diary Symptom frequency, bur- den, and severity Psychosocial impact Physical impairment 1 day Has been used in clinical trials DLQI=Dermatology Life Quality Index; PSA=Psoriasis Symptom Assessment; PSI=Psoriasis Symptom Inventory

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