New treatment guidelines for plaque psoriasis have been issued in the U.S. where 50 percent of patients say they are dissatisfied with treatment.
The National Psoriasis Foundation has issued treatment guidelines for plaque psoriasis - the first such treatment targets in the United States where 50 percent of patients say they are dissatisfied with treatment.
“Without treatment goals, clinicians and patients have no defined targets during the treatment course, and substantial variability exists in treatment expectation and quality of care. Therefore, determining treatment targets is critical for defining treatment expectations and optimizing psoriasis management in the United States,” wrote the authors of the recommendations which were published in the Nov. 28 issue of the Journal of the American Academy of Dermatology.
The guidelines are derived from a literature review, input from 25 psoriasis experts (Delphi rounds) and patient feedback.
To measure treatment response, April W. Armstrong, M.D., MPH and colleagues recommend the use of “body surface area (BSA)” with the first measure beginning three months after the start of new therapies:
· A BSA of 3 percent or less or a BSA improvement of 75 percent or less from baseline is considered an acceptable response.
· A BSA of 1 percent or less is recommended for target therapy three months after starting therapy.
· During the maintenance period, experts suggest evaluation every six months.
· A BSA of 1 percent or less is the target response at every six months during maintenance evaluation.
“Not meeting the treatment target should prompt discussions between the provider and the patient about treatment options based on benefit-risk assessment. These discussions need to account for the multitude of clinical, socioeconomic and behavioral factors that influence treatment outcomes and may necessitate treatment re-evaluations.
The clinicians and patients should discuss all relevant treatment options in order to maximize the likelihood of meeting treatment targets; the management options may include but are not limited to treatment escalation with the same treatment, combination therapies with other agents, or switching treatments. These discussions also need to take into account a continual assessment of patient satisfaction,” the authors wrote.
Psoriasis treatment goals in Europe
In Europe, successful treatment is defined as a decrease in the Psoriasis Area and Severity Index (PASI) score of 75 percent or greater. Treatment failure is defined as a decrease in the PASI score of less than 50 percent necessitating a new treatment. An intermediate response of a decrease in the PASI score of 50 percent or more, but less than 75 percent with Dermatology Life Quality Index (DLQI) score 5 or less, can lead to continuing the current course of treatment. A decrease in the PASI score of 50 percent or greater (but less than 75% with DLQI score greater than five) warrants modifying treatment.
Psoriasis treatment goals in Canada
In Canada, the treat-to-target goal is a Physician Global Assessment (PGA) score of zero.
Approved treatments for psoriasis
The U.S. Food and Drug Administration has approved 10 biologics and disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of plaque psoriasis. Despite this, patients report going without treatment or inadequate treatment leading to increased disease burden and a decreased quality of life with a host of associated comorbidities, such as inflammatory arthritis, cardiovascular diseases and depression.
April W. Armstrong, MD, MPH; Michael P. Siegel, PhD; Jerry Bagel, MD; et. al. "From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis," Journal of the American Academy of Dermatology. Published online Nov. 28, 2016. DOI: http://dx.doi.org/10.1016/j.jaad.2016.10.017