OBJECTIVES: A 75% improvement in the Psoriasis Area and Severity Index (PASI 75) is generally considered the clinical gold standard of treatment efficacy in patients with psoriasis. Outcomes for patients who achieve PASI 75 but not higher levels of response such as 90% or 100% PASI improvement (PASI 90 or PASI 100) are not fully characterized. This evaluation summarized the incremental benefits in outcomes such as health-related quality of life (HRQoL) of achieving complete or near-complete resolution of psoriasis, indicated by PASI greater than or equal to 90 and/or Physician Global Assessment (PGA) score of 0, compared with lesser response.
METHODS: A targeted literature search was conducted in the PubMed and Embase databases using a date limit of 10 years (January 1, 2005–March 10, 2015). Various search terms were used, including Medical Subject Heading (MeSH) and free-text terms. One reviewer performed level l screening on 328 titles and abstracts and level 2 screening on 92 full-text articles.
RESULTS: A total of 20 articles were ultimately selected that focused on the added value of achieving complete or near-complete resolution of psoriasis. Several analyses of clinical studies of adalimumab, infliximab, ixekizumab, brodalumab, and mixed treatments have indicated that achieving PASI 90, PASI 100, and/or a PGA score of 0 yields benefits as demonstrated by significant improvements in patient-reported outcomes (e.g., Dermatology Life Quality Index score, measures of symptom severity, concomitant topical medication use) compared with a lower PASI or PGA response.
CONCLUSIONS: This literature summary provides further evidence that complete or near-complete resolution in psoriasis is associated with better patient-reported outcomes. Accordingly, establishing complete or near-complete resolution as the therapeutic goal would have a significant impact on HRQoL and other outcomes in patients with moderate to severe psoriasis.
