Psoriasis treat to target: defining outcomes in psoriasis using data from a real‐world, population‐based cohort study (the British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR )

Abstract

Background The 'treat to target' paradigm improves outcomes and reduces costs in chronic disease management but is not yet established in psoriasis. Objectives To identify treatment targets in psoriasis using two common measures of disease activity: Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA). Methods Data from a multicentre longitudinal U.K. cohort of patients with psoriasis receiving systemic or biologic therapies (British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR) were used to identify absolute PASI thresholds for 90% (PASI 90) and 75% (PASI 75) improvements in baseline disease activity, using receiver operating characteristic curves. The relationship between PGA (clear, almost clear, mild, moderate, moderate-severe, severe) and PASI (range 0-72) was described, and the concordance between absolute and relative definitions of response was determined. The same approach was used to establish treatment response and eligibility definitions based on PGA. Results Data from 13 422 patients were available (58% male, 91% white ethnicity, mean age 44Á9 years), including over 23 000 longitudinal PASI and PGA scores. An absolute PASI ≤ 2 was concordant with PASI 90 and an absolute PASI ≤ 4 was concordant with PASI 75 in 90% and 88% of cases, respectively. These findings were robust to subgroups of timing of assessment, baseline disease severity and treatment modality. PASI and PGA were strongly correlated (Spearman's rank correlation coefficient 0Á92). The median PASI increased from 0 (interquartile range 0-0, range 0-23) to 19 (interquartile range 15-25, range 0-64) for PGA clear to severe, respectively. PGA clear/almost clear was concordant with PASI ≤ 2 in 90% of cases, and PGA moderate-severe severe was concordant with the National Institute for Health and Care Excellence PASI eligibility criteria for biologics in 81% of cases. Conclusions An absolute PASI ≤ 2 and PGA clear/almost clear represent relevant disease end points to inform treat-to-target management strategies in psoriasis.

The National Psoriasis Foundation psoriasis treatment targets in real‐world patients: prevalence and association with patient‐reported outcomes in the Corrona Psoriasis Registry

“…26 Of interest, a recent study using data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) suggested an absolute PASI ≤ 2 as a new treatment target; though studies evaluating the proportion of patients achieving this target in longitudinal cohorts are warranted. 27 While comparative effectiveness was not assessed per se in this study, 81% of our cohort were receiving biologics, considered highly effective in psoriasis. The low rates of patients meeting the target in the Corrona Registry may suggest lower efficacy of these therapies in real-world settings compared with that previously seen in randomized clinical trials and other postmarketing studies.…”

“…The score ranges from 0 to 30, with higher scores indicating greater effect. 15 Patients were also categorized into 'effect on life' categories based on their DLQI score: none (0-1), small (2-5), moderate (6-10) and very/extremely large (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The EQ-5D-3L measures overall health status based on a visual analogue scale (VAS) from 0 to 100 (higher values indicating better health) and by asking individuals whether they have no problems, some problems, or extreme problems for five dimensions: mobility, self-care, usual activities, pain/discomfort, anxiety/depression.…”

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

“…These studies confirmed secukinumab as an important treatment option for patients with moderate-to-severe plaque psoriasis confirming the solid evidence base established from randomized clinical trials. Nevertheless, greater clinical relevance has been recently attributed to the absolute PASI score compared to the relative PASI score (25)(26)(27)(28). Different absolute PASI scores have been suggested as clinical endpoints, useful to assess clinical response to treatments (27,28).…”

“…Different absolute PASI scores have been suggested as clinical endpoints, useful to assess clinical response to treatments (27,28). Moreover, absolute PASI values have been identified and increasingly reported as therapeutic targets in a treat-totarget strategy (25)(26)(27).…”

“…Indeed, the effectiveness of antipsoriatic treatments is usually reported as the relative 75%, 90%, or 100% improvement from baseline on the Psoriasis Area Severity Index (PASI 75, PASI 90, PASI 100), though there is emerging interest in the evaluation of absolute PASI score reduction as a better benchmark of therapeutic response and the higher clinical relevance of the remaining absolute PASI score as therapeutic target (i.e. PASI score 0-1, PASI score 2, PASI score 3, and PASI 5) (25)(26)(27). A recent analysis of data from the CLEAR study found that PASI ranges strongly correlated with Dermatology Life Quality Index (DLQI) score (28).…”