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J Am Acad Dermatol. 2017 Feb;76(2):290-298. doi: 10.1016/j.jaad.2016.10.017. Epub 2016 Nov 28.

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

Author information

1
Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: aprilarmstrong@post.harvard.edu.
2
National Psoriasis Foundation, Portland, Oregon.
3
Windsor Dermatology, East Windsor, New Jersey; University Medical Center of Princeton at Plainsboro, Plainsboro, New Jersey.
4
Tulane University School of Medicine, New Orleans, Louisiana.
5
University Hospitals Case Medical Center, Cleveland, Ohio.
6
University of Utah School of Medicine, Salt Lake City, Utah.
7
University of California, San Diego School of Medicine, La Jolla, California.
8
Northwell Health and Hofstra North Shore University Hospital, Long Island Jewish Medical Center School of Medicine, Manhasset, New York.
9
University of Pennsylvania, Philadelphia, Pennsylvania.
10
Tufts University School of Medicine, Boston, Massachusetts.
11
University of California San Francisco Medical Center, San Francisco, California.
12
Icahn School of Medicine at Mount Sinai, New York, New York.
13
St Louis University Medical School, St Louis, Missouri.
14
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
15
Baylor University Medical Center and Texas A&M Health Science Center, Dallas, Texas.
16
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
17
Eastern Virginia Medical School, Norfolk, Virginia; Virginia Clinical Research Inc, Norfolk, Virginia.
18
George Washington University, Washington, District of Columbia.
19
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
20
Keck School of Medicine, University of Southern California, Los Angeles, California.
21
Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
22
Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
23
Eastern Virginia Medical School, Norfolk, Virginia.

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

PMID:
27908543
DOI:
10.1016/j.jaad.2016.10.017
[Indexed for MEDLINE]
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