Correlation between Dermatology Life Quality Index and Psoriasis Area and Severity Index in patients with psoriasis: A cross-sectional Global Healthcare Study on Psoriasis
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Good morning and welcome to the twelfth issue of Special Reports: Skin Spectrum Weekly presents “Vender on Psoriasis.” This series is based on Dr. Vender’s popular column appearing in each edition of The Chronicle of Skin & Allergy, which offers expert commentary and opinions on current clinical developments in PsO. We’d love to get your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
Correlation between Dermatology Life Quality Index and Psoriasis Area and Severity Index in patients with psoriasis: A cross-sectional Global Healthcare Study on Psoriasis
The Global Healthcare Study on Psoriasis (GHSP) is a comprehensive international research initiative conducted across multiple countries and continents since January 2020. This longitudinal observational study collects cross-sectional data from specialized dermatology centres in Europe (Switzerland), Latin America (Brazil and Chile), Asia (China and Singapore), and North America (USA). The aim of the GHSP is to collect a comprehensive dataset to analyze the impact of psoriasis on patients' lives globally and evaluate treatment effectiveness across different regions.
Adult patients diagnosed with psoriasis by dermatologists participate in the GHPS survey, providing socio-demographic information and details about their disease and treatment history. The survey questions in the GHSP are akin to those used in prominent European registries like the Swiss Dermatology Network for Targeted Therapies (SDNTT), the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), and the German Psoriasis Registry (PsoBest). Patient demographics such as sex, age, educational background, ethnicity, psoriatic arthritis status, and body mass index are documented. Additionally, the severity of psoriasis is assessed using metrics like PASI, DLQI, and BSA by healthcare professionals.
This aspect of the GHSP (Acta Dermato-Venereologica 2024; 104:20329) looked at the correlation between the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) in patients with psoriasis. A total of 1,158 psoriasis patients from various regions, including Switzerland, Latin America, Asia, and the U.S. were included. The research aimed to compare the relationship between PASI and DLQI across different geographical areas. The study found correlations between PASI and DLQI in all regions, with varying impacts of patient characteristics on DLQI across different continents.
In Switzerland and Latin America, factors such as current age, age at diagnosis, sex, body mass index, psoriatic arthritis, and education influenced DLQI scores. The research highlighted that an increase in PASI had a more pronounced effect on quality of life in patients from Europe and those already experiencing significant quality of life impairment. The study emphasized the importance of tailoring treatment guidelines based on geographical regions to enhance patients’ quality of life and mitigate disease severity globally.
Comment: Quite often the quality of life is measured by local regions, but this cross-sectional study is global. One would expect that the DLQI and the PASI be related and correlated, and this was shown and proven globally. Small differences were noted, such as that PASI, when increased, had a larger effect of the quality of life in patients from Europe. However, it is reassuring to note that generally a high PASI denotes a high DLQI and improvement of the PASI is correlated with a better quality of life and a improvement of DLQI.
Tildrakizumab for the treatment of moderate-to-severe psoriasis: A 52-week, real-world Portuguese multicentric study
The study conducted in Portugal assessed the real-world effectiveness and safety of tildrakizumab in treating moderate-to-severe psoriasis over a 52-week period (Drugs in Context 2024; 13:2023-12-5). In this multicentric, prospective study, adult patients with psoriasis received tildrakizumab 100 mg at specific intervals and were monitored for a year. The primary focus was on Psoriasis Area and Severity Index (PASI) scores at different time points.
Results from the study showed promising outcomes. A total of 54 patients participated, with a mean age of 50.3 years, and more than half were male. Notably, about 74% of patients had comorbidities, with psoriatic arthritis being the most common. By week 52, there was a significant improvement in PASI scores, with a remarkable decrease from baseline to 1.3, indicating a 93% overall improvement. The majority of patients achieved PASI scores indicating significant improvement in their condition.
Regarding safety, infections were observed in a small percentage of patients, and only one patient required hospitalization. The study also highlighted that nearly 90% of patients continued treatment at the end of the 52-week period.
This real-world study demonstrated that tildrakizumab is an effective and safe treatment for moderate-to-severe psoriasis in diverse clinical settings. The findings align with previous controlled trials, following the drug’s efficacy and tolerability over an extended period in a real-world scenario. This study contributes valuable insights into the practical application of tildrakizumab for psoriasis treatment beyond traditional clinical trial settings, providing clinicians with essential information for decision-making in patient care.
Comment: Tildrakizumab was the first anti IL-23 biologic studied for psoriasis. It has the longest safety data and efficacy data available for this class of medication. This Portuguese study looked at 54 patients who had many comorbidities including psoriatic arthritis. Despite this, the average improvement of PASI scores was 93% at one year. Also, this study showed that almost 90% of patients remained on treatment at one year, showing great survival of this drug. Minimal side effects were noted. This shows that tildrakizumab is a safe, effective, and durable treatment for patients who have moderate to severe psoriasis with the convenience of a q 12 week dosing regimen.
Real-world effectiveness, drug survival and safety of risankizumab over a period of two years in 158 patients with moderate-to-severe plaque psoriasis
In a recent letter to the editor of the Journal of the European Academy of Dermatology and Venereology (2024 Mar 20. doi: 10.1111/jdv.19956), researchers presented findings on the real-world effectiveness, drug survival, and safety of risankizumab in 158 patients with moderate-to-severe plaque psoriasis over a two-year period. Risankizumab, a monoclonal antibody targeting the IL-23 pathway, has shown superior efficacy in Phase III trials compared to other treatments, with significant proportions of patients achieving PASI 100 and PASI 90.
The study aimed to assess treatment response rates at various time points, clinical factors influencing effectiveness, and secondary endpoints such as mean PASI scores, adverse events, drug survival rates, and reasons for discontinuation. Results showed promising outcomes with 50% of patients achieving PASI ≤3 after four weeks of treatment, increasing to over 90% at 52 and 104 weeks. Notably, PASI 100 was achieved by 81% and 71% of patients at Weeks 24 and 52, respectively.
Multimorbidity and certain clinical factors like joint involvement, baseline PASI, and disease duration were found to impact treatment success. Previous treatments did not significantly affect response to risankizumab. The study reported no severe drug-related adverse events or discontinuations due to adverse events, with a high drug survival rate of 93.1% at 52 weeks.
Overall, this real-world study confirms the high effectiveness and favourable safety profile of risankizumab in treating plaque psoriasis. It underscores the importance of considering clinical characteristics when assessing response to treatment.
Comment: Risankizumab is a very versatile anti-IL-23 biologic approved for use in psoriasis, psoriatic arthritis, and Crohn’s disease. For psoriasis, PASI 90 occurs in over 90% of patients at weeks 24 and 52 with PASI 100 achieved in over 70% of patients at six months and one year. Previous failures to other biologics do not affect the response to risankizumab. No discontinuations due to side effects occurred, with over 93% of patients staying on risankizumab at one year. This drug has been found to be an extremely popular choice for dermatologists to treat their patients suffering from psoriasis.
If you find the contents of this newsletter interesting, please check out the Vender on Psoriasis podcast. It’s available at Apple iTunes, Stitcher, Spotify, or wherever you get your podcasts.
Dr. Ron Vender is a Hamilton-based certified dermatologist with over 30 years of clinical practice experience and over 100 clinical trials in psoriasis. He is founder and director of Dermatrials Research Incorporated and Venderm Consulting, specializing in treatments and management solutions for individuals with psoriasis.
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