Practical considerations in future psoriasis therapies (original) (raw)
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The unmet treatment need for moderate to severe psoriasis: results of a survey and chart review
Journal of the European Academy of Dermatology and Venereology, 2006
Conventional systemic therapies and phototherapy for psoriasis are limited by safety concerns that may preclude long-term treatment with these agents. To estimate the unmet need for safe and effective treatments for psoriasis. A survey was conducted at three psoriasis outpatient clinics in Europe. Male and female patients of any age with psoriasis requiring more than topical treatment were eligible to participate in the survey. Patient data were obtained from patients' answers to a questionnaire as well as by a chart review of each participating patient. The survey questionnaire addressed various aspects of psoriasis, including demographics and disease characteristics, treatment history, pre-existing medical conditions, and patient satisfaction with treatments received. A total of 301 patients participated in the survey, with approximately 100 patients from each centre. Nearly 90% of patients had received at least one systemic therapy or phototherapy for psoriasis, with 39% of patients receiving three or more. Ultraviolet B (UVB), methotrexate, psoralen plus ultraviolet A (PUVA), retinoids and cyclosporin were the most commonly used agents. Inadequate response, reported by patients as no change or worsening of disease with treatment, ranged from 10% to 50%. Contraindications to conventional systemic therapies were reported by 9-22% of patients. A substantial number of patients (42%) were not satisfied with these therapies. This survey highlights the unmet need for safe and effective therapies for moderate to severe psoriasis.
The outcomes movement and new measures of the severity of psoriasis
Journal of the American Academy of Dermatology, 1996
Traditionally physicians have assessed the severity of psoriasis on the basis of involved surface area or other physical features. These measures are not highly reliable and do not quantify the extent to which the disease affects the patient. New approaches to health care assessment have been developed, including evaluation of the outcome of medical care. This new direction in health care assessment has been described as the "outcomes movement." This emphasizes the assessment of patients' outcomes with respect to quality of life and functional capacity, rather than traditional techniques that rely on the results of physical or laboratory examinations. New measures to assess treatment effectiveness will almost certainly be used to allocate health care resources. We review the status of measures of psoriasis and the implications of newer methods for assessing disease impact and outcomes of therapy. (J AM ACAD DERMATOL 1996;34:534-8.) Psoriasis is a chronic but dynamic skin disease, the extent and location of which change over time. Patients with psoriasis often ascribe a substantial negative effect on their quality of life to this disease or its treatment. 1-3 The psychosocial effects may be profound and may result in considerable stigmatization, social isolation, and discrimination. 4 John Updike 5 described psoriasis as "singling you out from the happy herds of normal mankind." Dennis Potter 6 vividly describes The Singing Detective with severe psoriasis as "... sunk down into his scabbed and scaled self, looks utterly miserable and uncommunicative." Psoriasis not only interferes with the activities of daily living and social functioning of those affected but can also impair the quality of life of their families. 2 Treatment time and avoidance of public places may interfere with family leisure time. Treatment may be hazardous and the cost is a further burden to the patient or society. 7, 8
Psoriasis is a chronic condition that has a significant negative impact on a patient’s quality of life (QoL). Measures of the clinical severity of psoriasis alone may not reflect patients’ perceptions of the impact of the disease on their lives. The aim of our study was to assess QoL in psoriasis patients who were candidates to receive one of the new biological treatments in order to obtain a more complete evaluation of the severity of the disease prior to treatment. A total of 180 patients were analysed, with all being affected by plaquetype psoriasis. The clinical severity of psoriasis was assessed by the Psoriasis Area and Severity Index, while QoL was assessed by three measures: the Dermatology Life Quality Index, the Skindex-29, and the Psoriasis Disability Index. Our results show how pervasive the impact of psoriasis is in patients who are candidates for the new biological treatments, and they further confirm the lack of a strong correlation between measures of clinical severity and QoL.
Research gaps in psoriasis: Opportunities for future studies
Journal of the American Academy of Dermatology, 2014
Over the past 2 decades, considerable progress has been made to further elucidate the complex pathogenesis of psoriasis, facilitating the development of a new armamentarium of more effective, targeted therapies. Despite these important advances, substantial deficits remain in our understanding of psoriasis and its treatment, necessitating further research in many areas. In the sixth section of the American Academy of Dermatology Psoriasis Guidelines of Care, gaps in research and care were identified. We discuss the most important gaps in research that currently exist and make suggestions for studies that should be performed to address these deficits. These encompass both basic science and clinical research studies, including large, prospective epidemiologic studies to determine the true prevalence and natural history of psoriasis; further molecular studies in patients with psoriatic and psoriatic arthritis to understand the function of psoriasis susceptibility genes and to identify novel therapeutic targets; studies to examine the role of environmental factors in the development of psoriasis; further investigation of the relationship between psoriasis and cardiometabolic disease; studies that examine the role of adjunctive therapies such as psychological interventions in appropriate patient groups; and finally, studies to identify biomarkers of disease severity and treatment response to optimize patient therapy. (J Am Acad Dermatol 2014;70:146-67.) Key words: adjunctive therapies; biologics; cardiovascular disease; comorbidities in psoriasis; comparative studies; disease severity; environmental factors in the development of psoriasis; future research studies; methotrexate; molecular studies in psoriatic and psoriatic arthritis; pathomechanisms and genetics of psoriasis; phototherapy; psoriasis; psoriasis guidelines; psoriasis treatment; psoriatic arthritis; psychological; research gaps; therapeutic targets; topical therapies.
Trials, 2012
Interest in health-related quality of life (HRQoL) outcome research in dermatology is increasing, especially in the systemic treatment of psoriasis with biologic agents. In other specialties, such as oncology, the application of a HRQoL intervention is considered to be an aid for monitoring disease and treatment over time, for the communication with the patient, and for improving treatment outcome. However, in dermatology practice, the application of this intervention is relatively new. Moreover, evidence on the effectiveness of a HRQoL intervention in dermatology is missing. It is hypothesized that the application of a HRQoL intervention in dermatology practice will have a positive impact on patients' HRQoL as well as on doctor-patient communication. In a prospective multicenter cluster randomized controlled trial, patients diagnosed with moderate to severe psoriasis who receive biologic treatment, will be followed for 48 weeks. The study sites, and not the patients, will be ra...
Redefining the therapeutic objective in psoriatic patients candidates for biological therapy
The Journal of dermatological treatment, 2017
The advances in psoriasis management currently allow achieving a good control of the disease. In particular, with the latest developed molecules, available evidence suggests that it is possible to pose an ambitious therapeutic goal, such as a Dermatology Life Quality Index 0/1, a Physician Global Assessment 0/1, or a Psoriasis Area and Severity Index 90/100 response. However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life. To optimize the treatment of psoriasis, it is not enough to define precisely the therapeutic objective, but also to adapt the therapeutic strategy to make the necessary modifications in case of not achieving it at the time point (at the end of the induction phase, or every 3-6 months) to be agreed with the patient (the so-called treat-to-target approach). In the present report, based on the Delphi methodology, 11 dermatologists from the Spanish Psoriasis Group...
Dermatology, 2012
Background: Although clinical studies have shown efficacy of biological agents in moderate to severe psoriasis, observational studies of real-world effectiveness are rare. Objective: To analyse the psoriasis area and severity index (PASI) and quality of life by the EQ-5D questionnaire and dermatology quality of life index (DLQI) in psoriasis patients who switched from conventional systemic treatment to biological agents in clinical practice. Furthermore, to analyse patient groups with the highest benefit of biological agents. Methods: Longitudinal, observational study based on the Swedish National Registry for Systemic Treatment of Psoriasis, PsoReg. Outcomes of biological-naïve patients who switched to a biological agent (n = 267) were analysed before switch and at the first follow-up. Results: Patients significantly improved in EQ-5D, DLQI and PASI (p ! 0.001). Patients with DLQI 6 10 and/or PASI 6 10 had the greatest benefits from biological agents in terms of EQ-5D. Conclusions: Patients with moderate to severe psoriasis benefit from biological agents in clinical practice; the patients with the highest benefits were those with high pretreatment PASI and DLQI scores.