New treatment targets for plaque psoriasis based on body surface area


By Will Boggs MD

NEW YORK (Reuters Health) - The National Psoriasis Foundation (NPF) has established new treatment goals for plaque psoriasis that rely on body surface area (BSA).

"These treatment targets help set a high bar for future medications," said Dr. April W. Armstrong from Keck School of Medicine of the University of Southern California, Los Angeles.

"That is, we expect very high levels of efficacy in the development of new medications for plaque psoriasis. Importantly, we also expect the safety profile of these medications to be good," she told Reuters Health by email.

Psoriasis affects nearly 8 million Americans, but before now there were no defined treatment targets for psoriasis in the U.S., Dr. Armstrong and colleagues write in a report online November 28 in the Journal of the American Academy of Dermatology.

The authors, current members of the NPF medical board and other psoriasis experts, used a Delphi process to establish defined treatment targets in order to inform treatment decisions, reduce disease burden, and improve patient outcomes in clinical practice.

After considering other measures - including Dermatology Life Quality Index, Psoriasis Area and Severity Index, and Physician Global Assessment - the experts agreed that the most preferred measure for establishing treatment targets is BSA.

The first evaluation after the start of treatment should take place at three months, regardless of therapy, and the target response should be measured every six months during maintenance therapy.

The panel defined an acceptable response after treatment initiation as either BSA <=3% or BSA improvement >=75% from baseline at three months after treatment initiation.

The target response, however, should be <=1% at three months after treatment initiation, and this response should be maintained during maintenance therapy, according to the consensus.

"While some consider these targets to be aggressive, these targets are actually achievable these days in a large proportion of psoriasis patients with advanced therapies or combination therapies," Dr. Armstrong said. "When we asked our patients, nearly all of them preferred clearance as the ultimate goal."

"These targets may make some providers feel uncomfortable because they may have patients who have not met the target," she said. "However, the purpose of having treatment targets is to encourage providers to pause and really think about how treatment regimens can be optimized."


J Am Acad Dermatol 2016.

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