Total skin clearance results in improvements in health-related quality of life and reduced symptom severity among patients with moderate to severe psoriasis

Abstract

Background: Newer therapies provide high levels of skin clearance in patients with moderate to severe psoriasis. However, insufficient evidence exists on the impact of total skin clearance from the patient's perspective. Objectives: To examine effects of total skin clearance on health-related quality of life (HRQoL) and psoriasis symptom severity in subjects with moderate to severe psoriasis. Methods: Pooled data from a phase 2 dose-ranging trial in psoriasis using brodalumab (antibody to interleukin-17 receptor A) were used to compare subjects with static physician global assessment (sPGA) 1 versus sPGA 0 and subjects with Psoriasis Area and Severity Index (PASI) 75 to 5100 versus PASI 100 at week 12 based on no impairment in Dermatology Life Quality Index (DLQI ¼ 0) and no psoriasis symptoms (Psoriasis Symptom Inventory ¼ 0). Results: Of subjects with sPGA 0 (clear) and 1 (almost clear), 61.4% and 45.7% had a DLQI ¼ 0 (p ¼ 0.15), and 65.5% and 32.6% had a Psoriasis Symptom Inventory ¼ 0 (p ¼ 0.001), respectively. Significantly more subjects with sPGA 1 continued to report itching, redness, scaling, and flaking compared to subjects with sPGA 0. Similar results were observed based on PASI score. Conclusions: A higher proportion of subjects with total skin clearance reported no impairment in HRQoL and no psoriasis symptoms than those who were almost clear.

Health-related quality of life in patients with psoriasis: a systematic review of the European literature

“…Furthermore, important clinical improvements in HRQoL follow the transition from almost clear to clear skin. This evidence suggests that achieving total skin clearance provides significant benefits to patients with moderate-to-severe psoriasis in terms of enhancing HRQoL [41,42]. In line with these results, some studies showed that patients who obtained the greatest improvement in the PASI also presented better HRQoL (as measured with the DLQI questionnaire), thus suggesting that therapeutic agents may demonstrate even further HRQoL benefits [43].…”

Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator–controlled VOYAGE 1 trial

“…At weeks 24 and 48, approximately half of all patients in the guselkumab group achieved complete clearance (IGA 0), which is associated with optimal HRQoL for patients with psoriasis. 29,30 Patient-reported outcome end points (PSSD and DLQI) based on total change, or indicating minimal/no impact on HRQoL or no symptoms or signs of psoriasis, demonstrated guselkumab responses superior to placebo at week 16 and adalimumab at weeks 24 and 48.…”

Phase 3 Studies Comparing Brodalumab with Ustekinumab in Psoriasis

“…PASI 100 was selected as the primary end point for the comparison of brodalumab with ustekinumab because it is an unambiguous end point and because complete clearance of skin disease is a goal of treatment in several guidelines. 21,22 Some patients with a response to therapy still have residual disease activity that continues to negatively affect health-related quality of life. PASI 100 responses were sustained in the majority of patients who continued treatment with 210 mg of brodalumab every 2 weeks.…”