A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

Abstract

Objective Treat‐to‐target (T2T) is an algorithm to reach a predefined outcome. Here, we define a T2T outcome for moderate‐to‐severe psoriasis vulgaris. Methods Briefly, the study included a literature review, discussions with key opinion leaders, recruitment of additional dermatologists with experience in managing moderate‐to‐severe psoriasis, 3 eDelphi survey rounds and a patient focus group. Relevant topics were selected during discussions prior to the survey for the statements. Surveys were based on the eDelphi methodology for consensus‐building using a series of statements. Consensus was defined as at least 80% of participants agreeing. A psoriasis patient focus group provided feedback on topic selection and outcome. Results A total of 5 discussions were held, and 3 eDelphi rounds were conducted with an average of 19 participants per round. The T2T outcome was set assuming shared decision between patient and dermatologist, awareness and referral for comorbidities by the dermatologist and appropriate treatment adherence by the patient. We defined ‘ideal’ and ‘acceptable’ targets; the latter referring to conditions restricting certain drugs. The T2T outcome was multidimensional, including ≥ ΔPASI90/75 or PGA ≤ 1, itch VAS score ≤ 1, absence of disturbing lesions, DLQI ≤ 1/3, incapacity daily functioning VAS score ≤ 1, safety ≤ mild side‐effects and full/mild tolerability of treatment for the ideal and acceptable target, respectively. Finally, time to achieve the T2T outcome was set at 12 weeks after initiation for all treatments. At all times, safety should not exceed the presence of mild side‐effects. Conclusion With this novel T2T composite outcome for psoriasis, clinicians and patients can make shared decisions on the treatment goals they envisage, as a guidance for future treatment steps – leading to a tight control management of the disease.

Psoriasis

“…There is an increasing global effort to adopt a treat-to-target approach to achieve better control of psoriasis and improve patient outcomes. [103][104][105] Thus, an absolute psoriasis area severity index equal to or under 2, or a physician's global assessment of clear or almost clear are realistic; these equate to a 90% reduction of psoriasis area severity index from baseline value (psoriasis area severity index 90) and to a dermatology life quality index of less than 5. 106…”

Response to Biologics During the First Six Months of Therapy in Biologic-naïve Patients with Psoriasis Predicts Risk of Disease Flares: A Danish Nationwide Study

“…Optimal response criteria have been discussed widely, currently with focus on absolute values, either single values of PASI, Physician Global Assessment (PGA), or body surface area (BSA) (14,15,(36)(37)(38) or composite outcomes (39). We provide here evidence of the importance of high clearance on stability and long-term outcome of psoriasis.…”

A New Classification of the Severity of Psoriasis: What’s Moderate Psoriasis?

“…Besides, severity and impact may fluctuate throughout a life span, and an individual patient may thus be classified differently at various points of the disease course. Targeted therapies and therapeutic goals in psoriasis warrant clear indications, criteria, and definitions as well [ 16 , 17 , 18 ].…”