Treatment goals for psoriasis: Should PASI 90 become the standard of care?

Psoriasis is a chronic, immune-mediated inflammatory disorder affecting 2--3% of general population, being both physically and emotionally debilitating. Due to the rapid advances in the understanding of psoriasis pathogenesis, several targeted medications, aiming specific components of the immune system, have been and are currently being developed. These biologic therapies are a major technological advancement over traditional immunosuppressive medications and have revolutionized the treatment of psoriasis. Currently available biologic agents for psoriasis treatment have shown to be very effective, even long-term, with a favorable safety profile. The most widely used instrument for objective measurement of psoriasis severity and extension is the Psoriasis Area and Severity Index (PASI), which was developed in 1978. Even though it has a number of limitations (non-linearity because of the surface score, notorious floor effect and poor sensitivity to change for relatively small areas of involvement, lack of ponderation of the different qualities of the lesions and functional impairment associated with lesions involving visible areas, such as, the hands, feet, nails or genital areas and reduced reproducibility due to the variability associated to the determination of BSA), PASI has been considered the gold standard of psoriasis severity scale for decades.

[1]  A. Kimball,et al.  Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies , 2014, Journal of the European Academy of Dermatology and Venereology : JEADV.

[2]  B. Elewski,et al.  Secukinumab in plaque psoriasis--results of two phase 3 trials. , 2014, The New England journal of medicine.

[3]  J. Gudjonsson,et al.  Novel systemic drugs under investigation for the treatment of psoriasis. , 2012, Journal of the American Academy of Dermatology.

[4]  T Fredriksson,et al.  Severe psoriasis--oral therapy with a new retinoid. , 1978, Dermatologica.

[5]  J. Saurat,et al.  Relationship between Clinical Response to Therapy and Health-Related Quality of Life Outcomes in Patients with Moderate to Severe Plaque Psoriasis , 2008, Dermatology.

[6]  K. Papp,et al.  Efficacy and safety of secukinumab in the treatment of moderate‐to‐severe plaque psoriasis: a randomized, double‐blind, placebo‐controlled phase II dose‐ranging study , 2013, The British journal of dermatology.

[7]  J. Krueger,et al.  IL-17 targeted therapies for psoriasis , 2013, Expert opinion on investigational drugs.

[8]  E. Sasso,et al.  Long-term efficacy and safety of adalimumab in patients with moderate to severe psoriasis treated continuously over 3 years: results from an open-label extension study for patients from REVEAL. , 2012, Journal of the American Academy of Dermatology.

[9]  A. Menter,et al.  Efalizumab: results of a 3-year continuous dosing study for the long-term control of psoriasis , 2008, The British journal of dermatology.

[10]  James T. Elder,et al.  Psoriasis: epidemiology. , 2007, Clinics in dermatology.

[11]  Subhashis Banerjee,et al.  Anti-interleukin-17 monoclonal antibody ixekizumab in chronic plaque psoriasis. , 2012, The New England journal of medicine.

[12]  J. Ortonne,et al.  Efficacy and safety of infliximab vs. methotrexate in patients with moderate‐to‐severe plaque psoriasis: results of an open‐label, active‐controlled, randomized trial (RESTORE1) , 2011, The British journal of dermatology.

[13]  D M Reboussin,et al.  Psoriasis causes as much disability as other major medical diseases. , 1999, Journal of the American Academy of Dermatology.

[14]  K. Reich,et al.  Efficacy of biologics in the treatment of moderate to severe psoriasis: a network meta‐analysis of randomized controlled trials , 2012, The British journal of dermatology.

[15]  S. Feldman,et al.  Psoriasis assessment tools in clinical trials , 2005, Annals of the rheumatic diseases.

[16]  F. Nestle,et al.  Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial , 2005, The Lancet.

[17]  J. Saurat,et al.  Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION) , 2007, The British journal of dermatology.

[18]  C. Griffiths,et al.  Definition of treatment goals for moderate to severe psoriasis: a European consensus , 2010, Archives of Dermatological Research.

[19]  S. Feldman,et al.  A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. , 2004, Journal of the American Academy of Dermatology.

[20]  J. Ortonne,et al.  Brodalumab, an anti-interleukin-17-receptor antibody for psoriasis. , 2012, The New England journal of medicine.

[21]  COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON CLINICAL INVESTIGATION OF MEDICINAL PRODUCTS INDICATED FOR THE TREATMENT OF PSORIASIS , 2004 .

[22]  L. Puig,et al.  Efficacy of biologics in the treatment of moderate‐to‐severe plaque psoriasis: a systematic review and meta‐analysis of randomized controlled trials with different time points , 2014, Journal of the European Academy of Dermatology and Venereology : JEADV.

[23]  A. Kimball,et al.  Long‐term efficacy of ustekinumab in patients with moderate‐to‐severe psoriasis treated for up to 5 years in the PHOENIX 1 study , 2013, Journal of the European Academy of Dermatology and Venereology : JEADV.