Why carry out this study?
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Patients with moderate-to-severe psoriasis suffer from negative impacts on their health-related quality of life (HRQoL) and significant psychosocial disability. |
Despite the availability of effective systemic therapy for these patients, many are undertreated, with a global study indicating that nearly 60% of patients fail to reach treatment goals. |
A consensus-based treat-to-target approach in psoriasis may better guide clinicians, leading to improved treatment outcomes and patient HRQoL. |
The ‘Treat to Target Italia’ project was undertaken by 10 psoriasis experts who developed 20 statements based on a literature review and results of a survey of Italian dermatologists; these statements were then reviewed by a panel of 28 dermatologists using the Delphi process to achieve consensus. |
What was learned from the study?
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Consensus was reached on all statements, including those on treatment goals defining remission: a 90% improvement from baseline in the Psoriasis Area and Severity Index (PASI90 response) or an absolute PASI score of less than or equal to 3. |
Dermatologists easily agreed on the treat-to-target strategy for patients with psoriasis that was patient-centred with emphasis on objective measures of disease severity and patient HRQoL, and on treatment safety. |
Digital Features
Introduction
Methods
Design
Development of Consensus Statements
Results and Discussion
Statements | Scores applied, n | Level of consensus, % | |||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | Total | ||
1.1 An adaptable and personalised strategy aimed at achieving the therapeutic objectives (i.e. treat to target) can be useful in psoriasis clinical practice | 0 | 0 | 0 | 4 | 24 | 28 | 100 |
1.2 Several factors should be considered when choosing a systemic treatment in patients with moderate-to-severe psoriasis. They include disease severity and localisation (i.e. sensitive areas), coexistence of psoriatic arthritis or other comorbidities, impact of the disease on the patient’s quality of life, patient’s preference and treatment risk–benefit ratio | 0 | 0 | 0 | 4 | 24 | 28 | 100 |
1.3 Dermatologists should use PASI or PGA or BSA to objectively assess psoriasis in daily practice | 0 | 1 | 6 | 6 | 15 | 28 | 96 |
1.4 The PASI90 response best defines the therapeutic objective | 0 | 2 | 3 | 11 | 12 | 28 | 93 |
1.5 The absolute PASI value that defines the optimal therapeutic objective should be less than or equal to 3 | 0 | 3 | 5 | 6 | 14 | 28 | 89 |
1.6 PASI90 or absolute PASI less than or equal to 3 could not be adequate treatment goals in the case of involvement of sensitive areas | 0 | 3 | 3 | 10 | 12 | 28 | 89 |
1.7 If the target of PASI90 or absolute PASI score less than or equal to 3 is not reached after 3–4 months of therapy, a change in treatment should be considered | 0 | 5 | 5 | 12 | 6 | 28 | 82 |
1.8 PASI90 or absolute PASI less than or equal to 3 should be maintained over time | 0 | 2 | 3 | 9 | 14 | 28 | 93 |
1.9 The impact of psoriasis on patient’s quality of life should be taken into consideration when considering treatment goals | 0 | 0 | 1 | 6 | 21 | 28 | 100 |
Statements | Scores applied, n | Level of consensus, % | |||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | Total | ||
2.1 Quality of life is an important outcome from the patient and physician perspective and should be included in the therapeutic targets. Achievement of treatment goal implies no impact or minimal impact of the disease on quality of life, e.g. DLQI less than or equal to 3 | 0 | 1 | 2 | 10 | 15 | 28 | 96 |
2.2 Treat to target in psoriasis should include patient-centric targets, such as patient satisfaction | 0 | 0 | 2 | 15 | 11 | 28 | 100 |
2.3 If the target of disease-related quality of life is not reached after 3–4 months of therapy, a change in treatment should be considered | 1 | 1 | 6 | 12 | 8 | 28 | 93 |
Statements | Scores applied, n | Level of consensus, % | |||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | Total | ||
3.1 Psoriasis-related systemic inflammation can affect joints, liver, nervous system and cardiovascular system | 0 | 0 | 5 | 6 | 17 | 28 | 100 |
3.2 Attention should be paid to early recognition of psoriatic arthritis | 0 | 0 | 0 | 6 | 22 | 28 | 100 |
3.3 Moderate-to-severe psoriasis can be associated with various comorbidities that can benefit from, or be worsened by, anti-psoriatic therapy | 0 | 0 | 5 | 5 | 18 | 28 | 100 |
3.4 Biological drugs showing a high selectivity in inhibiting inflammatory signals can improve comorbidities that share pathogenic pathways with psoriasis | 0 | 2 | 3 | 8 | 15 | 28 | 93 |
3.5 In obese patients, body weight reduction may positively impact on overall response to anti-psoriatic therapy | 0 | 0 | 2 | 8 | 18 | 28 | 100 |
Statements | Scores applied, n | Level of consensus, % | |||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | Total | ||
4.1 Safety should be considered as important as efficacy | 0 | 0 | 3 | 3 | 22 | 28 | 100 |
4.2 Targeted therapies show a very favourable safety profile | 0 | 0 | 2 | 13 | 13 | 28 | 100 |
4.3 Safety should be assessed periodically, according to the patient’s and drug’s characteristics | 0 | 0 | 2 | 7 | 19 | 28 | 100 |