Updates on Psoriasis and Cutaneous Oncology: Proceedings from the 2016 MauiDerm Meeting based on pre
In a retrospective study of patients with moderate-to-severe psoriasis treated with biologics (adalimumab and etanercept), methotrexate, or placebo drawn from several recent clinical trials (n=11,015 patient-visits), a total of 534 had a Physician’s Global Assessment (PGA) score of “clear” and 1,725 of “minimal.”1 A subset of these 2,259 patient-visits had a Patient’s Global Assessment (PtGA) of “uncontrolled” (n=60) or “limited disease control” (n=450). In those patients with a PGA of “clear” or “minimal,” the factors most associated with increased odds of patient-assessed limited disease control or uncontrolled disease were: pain, pruritus, and current joint inflammation. Pain (defined as 10mm on a visual analog scale [VAS]) was associated with a 12-percent increase (odds ratio [OR] 1.12, 95% confidence interval [CI], 1.01–1.23, p=0.027), pruritus with a 49-percent increase (1.49, 95% CI, 1.38–1.60, p<0.001), and current joint inflammation with a 67-percent increase (1.67 OR, 95% CI, 1.19–2.34, −p=0.003). Thus, persistent symptoms are associated with a patient perception of uncontrolled or limited control of psoriasis even if the assessing practitioner views the disease as clear or almost clear.
The metrics differ in terms of how clinicians evaluate psoriasis versus patient-reported outcomes. Clinicians use the Psoriasis Area and Severity Index (PASI),2 the Physician’s or Investigator’s Global Assessment (PGA or IGA),3,4 and body surface area (BSA)5 evaluations. On the other hand, patient-reported outcomes are generally expressed using the Dermatology Life Quality Index (DLQI)6 or psoriasis-specific tools, such as the Psoriasis Symptom Assessment (PSA) Scale,7 the Psoriasis Symptom Diary,8 or the Psoriasis Symptom Inventory (PSI).9 Obviously, these tools capture different aspects of psoriasis (Table 1).
Updates on Psoriasis and Cutaneous Oncology: Proceedings from the 2016 MauiDerm Meeting based on presentations by.
J Clin Aesthet Dermatol.