Psoriasis patients see great benefit in achieving complete skin clearance

From patients’ point of view, reaching Psoriasis Area and Severity Index (PASI) responses of 90/100 is often linked to an emerging feeling of large benefit through treatment. The likelihood of a 0/1 score in the Dermatology Life Quality Index (DLQI) is heightened by factors such as biologic therapy and higher age.

How important are high levels of skin clearance for patients with psoriasis and their quality-of-life? To answer this question, Prof. Matthias Augustin (University Medical Centre Hamburg, Germany) and his group performed a retrospective cohort study based on data from the PsoBest registry [1]. The study analysed PASI, DLQI, and Patient Benefit Index (PBI) 1 year after starting systemic treatment for psoriasis. Over 3,800 adults with moderate-to-severe disease who continued until visit 4 at 12 months were evaluated. As for previous treatments, 45.2% never had systemic therapy, and 14.9% already had been on biologics, the latter representing 41.3% of systemic treatments.

The clinical outcomes revealed that about one-third of patients presented with PASI 100 or 90/100 after 1 year. This coincided with a DLQI of 0/1, which stands for “no impact on quality-of-life” in 47.2% of cases. However, around 10% of patients still had a DLQI >10.

Assessing therapy achievements from the patients’ point of view, PBI values of ≥3.5 were observed in 24.2% of cases, indicating the highest treatment benefit. Again, a high level of skin clearance showed a positive effect on this outcome: PASI100 and 90/100 were associated with 49% and 36.1% of PBI ≥3.5, respectively, while this score was only achieved by 10.4% of those with PASI <75 (see Figure).

Figure: Skin clearance improvements in relation to Patient Benefit Index (PBI) [1]



Several baseline factors have an impact on the likelihood of an unimpaired quality-of-life (DLQI 0/1). The odds were increased by treatment with biologics (P<0.001), higher age (P=0.002), and longer-standing disease (P=0.004). The chances of DLQI 0/1 were lower in the case of >2 comorbidities (P=0.004), female sex (P=0.001), and raised BMI (P=0.002).

In his summary, Prof. Augustin highlighted 3 aspects of the results: only a minority of psoriasis patients achieved complete skin clearance after 12 months of systemic treatment; those with better skin clearance reached a DLQI 0/1 or a PBI ≥3.5 at higher proportions; and a completely cleared skin is of key importance for the patients.

1. Augustin M, et al. Value of skin clearance on patient-reported quality of life and treatment benefit, in patients with moderate to severe psoriasis in Germany. BOS10, SPIN 2022 Congress, 06–08 July, Paris, France.

 

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Posted on 26 August 2022