Psoriasis Severity Assessment Combining Physician and Patient Reported Outcomes: The Optimal Psoriasis Assessment Tool (original) (raw)
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The Simplified Psoriasis Index (SPI): A Practical Tool for Assessing Psoriasis
Journal of Investigative Dermatology, 2013
The Simplified Psoriasis Index (SPI) is a summary measure of psoriasis with separate components for current severity (SPI-s), psychosocial impact (SPI-p), and past history and interventions (SPI-i). It derives from the Salford Psoriasis Index but replaces Psoriasis Area and Severity Index (PASI) with a composite weighted severity score designed to reflect the impact of psoriasis affecting functionally or psychosocially important body sites. Two complementary versions are available, differing only in that current severity (SPI-s) is either professionally (proSPI-s) or patient self-assessed (saSPI-s). This study examined the criterion and construct validity and response distribution of proSPI-s, saSPI-s, and SPI-p in 100 patients with plaque psoriasis. A further 50 patients were assessed for test-retest reliability of these three components. Interrater reliability of proSPI-s was assessed in 12 patients, each assessed by 12 assessors (144 assessments). There was close correlation between PASI and proSPI-s (r ¼ 0.91); SPI-p was closely correlated with the Dermatology Life Quality Index (r ¼ 0.89). Strong intrarater (proSPI-s, saSPI-s, SPI-p, and SPI-i) and interrater (proSPI-s) reliability was demonstrated (all intraclass correlation coefficients 40.75). There were wide response distributions for all three components. We believe that both professional (proSPI) and self-assessed (saSPI) versions can readily be introduced into routine clinical practice.
Dermatology and Therapy
Introduction: Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA) are the most widely used outcome measures in clinical trials of biologics to treat psoriasis; however, these outcome measures vary in both their reliability and validity. As newer biologics approach complete clearance of psoriasis, it becomes important to have standardized, reproducible forms of measure to accurately compare treatment efficacy. The aim of this study was to evaluate the extent of and reasons for variation between PASI and PGA scores used in clinical trials. Methods: A literature search was conducted of clinical trials meeting the inclusion criteria: phase 2 or 3, evaluation of treatment efficacy in reducing psoriasis severity, and use of PASI 90/100 and sPGA or PGA 0/1 as primary end points. Results: Among the analyzed studies, 8 of 45 trials had a PASI-PGA variance of \ 5%, 4 of 45 trials had a variance of 5-10%, and 33 trials had a variance of [ 10%. The IMMvent and AMA-GINE trials were the only two trials showing 0 variation between the PASI and PGA scores, testing adalimumab and brodalumab, respectively. Ustekinumab showed the highest variance of 61.9% in the IXORA-S trial. Limitations of this paper include a relatively low number of studies assessed because of the paucity of literature available. Conclusions: The use of both PASI and PGA as equivalent assessment tools for complete clearance is redundant and subject to high variability. Novel severity assessments should be developed that reduce calculation variation and take into account patient-oriented symptoms.
Journal of Dermatological Science, 2021
Background: Plaque psoriasis significantly affects patients' health-related quality of life. To aid treatment decisions, not only objective assessment by physicians but also subjective assessment by patients is important. Objective: To assess the significance of Dermatology Life Quality Index (DLQI) evaluation at the time of biologics introduction in clinical practice in Japanese patients with plaque psoriasis. Methods: This was a single-arm, open-label, multicenter study. At baseline, Psoriasis Area and Severity Index (PASI) and DLQI scores were measured and stratified based on DLQI scores 6/5 and PASI scores 10/>10. Other patient-reported outcomes assessed included EQ-5D-5L, itch numerical rating scale (NRS), skin pain NRS, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), Sleep Problem Index-II (SPI-II), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). Results: Of the 73 enrolled patients, 23 had PASI scores 10. Those with PASI/DLQI scores >10/6 had a significantly higher median PASI score than those with PASI/DLQI scores >10/5 (p = 0.0125). Regardless of PASI scores (>10/10), median itch NRS and GAD-7 scores were significantly higher in patients with DLQI scores 6 than in those with DLQI scores 5 (itch NRS, p = 0.0361 and p = 0.0086, respectively; GAD-7, p = 0.0167 and p = 0.0273, respectively). Patients with PASI/DLQI scores 10/6 had significantly higher skin pain NRS (p = 0.0292) and PHQ-8 (p = 0.0255) scores and significantly lower median SPI-II scores (p = 0.0137) and TSQM-9 Effectiveness domain scores (p = 0.0178) than those with PASI/DLQI scores 10/5. Conclusion: DLQI may be useful for assessing patients' concerns that cannot be identified by PASI alone while initiating biologics or switching from other biologics in clinical practice.
International Journal of Research in Pharmaceutical Sciences, 2020
Psoriasis is a common chronically relapsing autoinflammatory disease of the skin affecting patients of all ages and both genders. There is a more significant impact on the quality of life in patients with established disease. The study was conducted to correlate the relation between dermatology life quality index and psoriasis area and severity index and thereby deriving the impact of one on the other. This is a cross-sectional, descriptive study undertaken in psoriasis patients who had disease manifestations but did not undergo any treatment. Patient’s DLQI and PASI were calculated at a given point of time. Fifty patients participated in the study. Thirty-three patients were men, with a mean age of 37 years, and seventeen patients were women with a mean age of 34 years. PASI & DLQI were tabulated and compared with age, gender, disease duration, occupation etc. PASI is a reliable parameter to measure the severity of disease and DLQI for measuring the quality of life in psoriatic pat...
Frontiers in Medicine, 2024
Introduction: Psoriatic arthritis (PsA) is a heterogeneous, chronic inflammatory disease that negatively impacts patients' quality of life. Patient-reported outcome measures (PROMs) are used to capture patient perspectives in disease assessment, and physicians use the Disease Activity Index for Psoriatic Arthritis (DAPSA) to evaluate disease activity in PsA. The study aimed to assess the relationship between PROMs and the DAPSA score in consecutive outpatients affected by PsA. Materials and methods: A cross-sectional study was conducted from March 2018 to October 2020 at the PsA clinic of the ARNAS Civico in Palermo (Italy), enrolling outpatients with PsA. Patients were assessed for their disease activity according to the DAPSA score, and PROMs, such as PHQ-9, HAQ, FACIT-F, and PsAID, were evaluated. Linear regression analysis evaluated the relationship between the DAPSA Score and the included PROMs. Results: 158 PsA consecutive peripheral subset psoriatic arthritis outpatients were recruited. The median years of illness was 10.6 (9.3-11.9), and the median DAPSA score was 19.02 (9-33.1). The regression analysis highlighted a strong relationship between the DAPSA score and the PsAID (adjR 2 26%, p < 0.0001), the FACIT-F (adjR 2 25.4%, p < 0.0001), the HAQ (adjR 2 23.7%, p < 0.0001), and PHQ-9 (adjR 2 15%, p < 0.0001). Conclusion: PROMs are strongly associated with the DAPSA score, but it allows in-depth evaluation of the impact of the disease on different domains of PsA patients' life.
Responsiveness to Change and Interpretability of the Simplified Psoriasis Index
Journal of Investigative Dermatology, 2013
The Simplified Psoriasis Index (SPI) is a summary measure of psoriasis with separate components for current severity (weighted for functionally or psychosocially important sites), psychosocial impact, and past behavior. The current severity components of the professionally assessed SPI (proSPI-s) and self-assessed SPI (saSPI-s) have each been shown to be valid and reliable. Their responsiveness to change and equivalence to the current standard (Psoriasis Area and Severity Index, PASI) were investigated. Responsiveness and minimum clinically important differences (MCIDs) were derived from PASI changes from baseline at weeks 4 (n ¼ 100) and 10 (n ¼ 65) in patients commencing therapy for psoriasis. Receiver operating characteristic (ROC) analysis confirmed that both measures detected responsiveness well (area under the curve (AUC) ¼ 0.72-0.96). On ROC and PASI-based anchor analysis, MCIDs equated to mean absolute and percentage changes of 5 and 60% (proSPI-s), and 7 and 70% (saSPI-s). Satisfactory response as defined by X75% reduction in PASI equated to 85 and 95% reductions in proSPI-s and saSPI-s, respectively. PASI-equivalent cutoff scores for mild (PASIo10) and severe (PASI420) psoriasis were o9 and 418 for proSPI-s (n ¼ 300) and o10 and 420 for saSPI-s (n ¼ 200; AUC ¼ 0.86-0.96). These studies further support the validity of SPI for use in routine clinical practice.
Psoriasis: Targets and Therapy, 2018
Background: The product of Physician Global Assessment and Body Surface Area (PGA × BSA) is a new outcome measure for psoriasis severity and response to therapy. The objective of this study was to evaluate PGA × BSA as an alternative to Psoriasis Area and Severity Index (PASI) for psoriasis assessments. Methods: The relationship between PASI and PGA × BSA was assessed in a post hoc analysis of pooled data from the PRISTINE (NCT00663052) and PRESTA (NCT00245960) trials in patients with moderate-to-severe psoriasis who received etanercept 50 mg/week. Data were analyzed using Spearman and intra-class correlation coefficients, effect sizes, scatterplots, Bland-Altman plots, and Kappa statistics. Results: Spearman correlations at baseline, week 12, and week 24 were strong for PGA × BSA versus PASI (r=0.78, 0.87, and 0.90, respectively; all P<0.0001) as were intra-class correlations (0.76 [95% confidence interval 0.73-0.80], 0.80 [0.76-0.83], and 0.85 [0.82-0.87], respectively). The effect size was −1.53 for PASI and −0.94 for PGA × BSA (baseline to week 24). Scatterplots and Bland-Altman plots detected a trend across the range of measurement. Kappa statistics (at 12 and 24 weeks) between PASI50/75/90 and 50/75/90% improvement in PGA × BSA showed good agreement (0.58-0.69 at week 12 and 0.63-0.67, respectively; all P<0.0001). At baseline, the Spearman correlation coefficients were 0.96, 0.51, 0.19, and 0.17 for PGA × BSA versus BSA, PGA, Patient Global Assessment, and Dermatology Life Quality Index, respectively (all P<0.001). Conclusion: PGA × BSA has advantages over PASI for measuring moderate-to-severe psoriasis; it is intuitive, sensitive, and easy to use.