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

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U pdates on Psoriasis and Cutaneous Oncology: Proceedings from the 2016 MauiDerm Meeting [ 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 ] 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 5 PSORIASIS UPDATE Patient-reported Outcomes: Association with Clinical Response to Psoriasis Therapies Patient-reported outcomes (PROs) of psoriasis control do not always align with objective clinical observations of the disease. PROs are inherently subjective, but these self-reported assessments can complement objective observations, provide important insights into how patients perceive their own disease and its treatment, and may help advance care by incorporating this point of view into how clinicians treat psoriasis. In a retrospective study of patients with moderate-to- severe psoriasis treated with biologics (adalimumab and etanercept), methotrexate, or placebo drawn from several recent clinical trials (n=11,015 patient-visits), a total of 534 had a Physician's Global Assessment (PGA) score of "clear" and 1,725 of "minimal." 1 A subset of these 2,259 patient-visits had a Patient's Global Assessment (PtGA) of "uncontrolled" (n=60) or "limited disease control" (n=450). In those patients with a PGA of "clear" or "minimal," the factors most associated with increased odds of patient-assessed limited disease control or uncontrolled disease were: pain, pruritus, and current joint inflammation. Pain (defined as 10mm on a visual analog scale [VAS]) was associated with a 12-percent increase (odds ratio [OR] 1.12, 95% confidence interval [CI], 1.01–1.23, p=0.027), pruritus with a 49-percent increase (1.49, 95% CI, 1.38-1.60, p<0.001), and current joint inflammation with a 67-percent increase (1.67 OR, 95% CI, 1.19–2.34, -p=0.003). Thus, persistent symptoms are associated with a patient perception of uncontrolled or limited control of psoriasis even if the assessing practitioner views the disease as clear or almost clear. The metrics differ in terms of how clinicians evaluate psoriasis versus patient-reported outcomes. Clinicians use the Psoriasis Area and Severity Index (PASI), 2 the Physician's or Investigator's Global Assessment (PGA or IGA), 3,4 and body surface area (BSA) 5 evaluations. On the other hand, patient-reported outcomes are generally expressed using the Dermatology Life Quality Index (DLQI) 6 or psoriasis-specific tools, such as the Psoriasis Symptom Assessment (PSA) Scale, 7 the Psoriasis Symptom Diary, 8 or the Psoriasis Symptom Inventory (PSI). 9 Obviously, these tools capture different aspects of psoriasis (Table 1). PROs related to psoriasis should meet four criteria. First, they should assess patient experiences most relevant to psoriasis. Second, they must frame questions in such a way that the patient can easily understand what is being asked and reply appropriately. Third, PRO tools should not place an unreasonable burden on the patient's ability to recall past events or sequences of events. Finally, any PRO that will be well-accepted by patients and clinicians must be easy to complete in about five minutes or less. 8 The DLQI tool lists 10 items that are not specific to psoriasis, such as symptoms (itchiness, pain, stinging sensations), feelings (embarrassment or self- consciousness because of skin), and how the condition might affect choice of clothing, leisure activities, work or study, relationships, and sex. The DLQI even allows patients to evaluate how much time and messiness is associated with their treatment. 6 The DLQI in patients Updates on Psoriasis and Cutaneous Oncology Proceedings from the 2016 MauiDerm Meeting based on presentations by George Martin, MD; Bruce E. Strober, MD, PhD; Craig L. Leonardi, MD; Joel M. Gelfand, MD, MSCE; Andrew Blauvelt, MD, MBA; Arthur Kavanaugh, MD; Linda Stein Gold, MD; Brian Berman, MD, PhD; Ted Rosen, MD; Eggert Stockfleth, MD

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