MedWire News: A reduction of at least 75% in Psoriasis Area and Severity Index score (PASI-75) is likely to result in significant health-related quality of life (HRQoL) benefits and should be the goal of dermatologists who treat psoriasis patients, say reviewers.

“The impact of psoriasis on patients’ HRQoL may have been underestimated in the past,” Kristian Reich (Dermatologikum Hamburg, Germany) and Christopher Griffiths (University of Manchester, UK) write in the Archives of Dermatological Research.

Recent research has rated the impact of psoriasis on HRQoL as similar to that of cancer, heart disease, and depression.

Although HRQoL is severely affected by psoriasis, the size of impact does not necessarily correlate with symptom severity. However, Reich and Griffiths cite data from trials of infliximab in moderate-to-severe psoriasis patients that show correlation between improvements in psoriasis symptoms and HRQoL.

Indeed, patients who lose their PASI-75 or -90 responses show an accompanying decline in HRQoL.

“Even among patients with complete clearance of psoriasis, not all report a Dermatology Life Quality Index of 0, indicating that treatment concerns and/or fear of disease exacerbation continue to influence wellbeing,” note Reich and Griffiths.

Data from both infliximab trials and studies of other biologics support the idea that patients must achieve a large improvement in skin symptoms (ie, PASI-75) before a large impact on HRQoL is seen.

“Therefore, the ultimate goal for the treatment and management of moderate-to-severe psoriasis should be to achieve clearance of skin and nail symptoms at the highest level possible and to sustain symptom clearance,” conclude the reviewers.

“This will have a significant impact on HRQoL.”

Journal