From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis

Abstract

Background: An urgent need exists in the United States to establish treatment goals in psoriasis.

Objective: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice.

Methods: The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre-Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds.

Results: A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or more from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less.

Limitations: Although BSA is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side effects.

Conclusion: With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.

Keywords: Physician Global Assessment; biologics; body surface area; outcome measures; psoriasis; systemic therapies; treat to target; treatment; treatment goals.