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)

Mahil, S.K. et al. (2020) 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). British Journal of Dermatology, 182(5), pp. 1158-1166. (doi: 10.1111/bjd.18333) (PMID:31286471) (PMCID:PMC7317460)

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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 44·9 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 0·92). 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.

Item Type:Articles
Additional Information:This work was supported by PSORT [which is in turn funded by a Medical Research Council (MRC) Stratified Medicine award (MR/ L011808/1)], The Psoriasis Association (RG2/ 10), the NIHR Biomedical Research Centre at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, the NIHR Manchester Biomedical Research Centre and the NIHR Newcastle Biomedical Research Centre. N.D. is supported by Health Data Research U.K. (MR/ S003126/1). N.J.R. is supported by the Newcastle MRC/EPSRC Molecular Pathology Node and the Newcastle NIHR Medtech and In Vitro Diagnostics Co-operative. C.E.M.G. is an NIHR Senior Investigator.
Keywords:Dermatology.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Burden, Professor David
Authors: Mahil, S.K., Wilson, N., Dand, N., Reynolds, N.J., Griffiths, C.E.M., Emsley, R., Marsden, A., Evans, I., Warren, R.B., Stocken, D., Barker, J.N., Burden, A.D., and Smith, C.H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:British Journal of Dermatology
Publisher:Wiley
ISSN:0007-0963
ISSN (Online):1365-2133
Published Online:08 July 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in British Journal of Dermatology 182(5): 1158-1166
Publisher Policy:Reproduced under a Creative Commons Licence

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