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Complete Skin Clearance and PASI response rates in clinical practice- Predictors, Health Related Quality of Life improvements and implications for treatment goals
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.ORCID iD: 0000-0002-3858-8474
2019 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133Article in journal (Refereed) Accepted
Abstract [en]

BACKGROUND: PASI90 is suggested to be the new standard endpoint RCTs of biologics for psoriasis, whereas treatment guidelines often still refer to PASI75.

OBJECTIVES: To analyse in a real-world setting: Firstly, what factors are associated with higher levels of treatment response to biologics. Secondly, the Health-Related Quality of Life gains associated with different response levels in clinical practice.

METHODS: Biologically-naïve patients with PASI, DLQI and EQ-5D outcomes before (maximum 6 months) and after (3-12 months) switch to biologics during registration in the Swedish Register for systemic treatment of psoriasis, PsoReg, were included (n=515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percent response levels.

RESULTS: High PASI percentage response was associated with higher PASI before switch and lower BMI. DLQI and EQ-5D improved within all responder groups (p<0·001). The magnitude of improvements in DLQI (p=0·02) differed between responder groups. The mean (SD) DLQI improvement for PASI75-<90, PASI90-<100 responders and patients achieving Complete Skin Clearance (PASI100) were 9·9 (7·4), 11·5 (7·0) and 8·0 (6·1), respectively.

CONCLUSION: PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack "baseline" PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI90 are thus not suitable for treatment guidelines or for follow-up in clinical practice. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019.
National Category
Clinical Medicine
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URN: urn:nbn:se:umu:diva-161758DOI: 10.1111/bjd.18361PubMedID: 31325318OAI: oai:DiVA.org:umu-161758DiVA, id: diva2:1339249
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-08-06

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Schmitt-Egenolf, Marcus

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