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Raam L, Hartmane I, Valiukevičienė S, Karamova AE, Telegdy E, Botev I, Marina D, Rubant S, Albuquerque T, Constantin MM. Disease severity, treatment patterns, and quality of life in patients with moderate-to-severe psoriasis routinely managed with systemic treatment: results of the CRYSTAL observational study in Central and Eastern European countries. Front Immunol 2024; 15:1410540. [PMID: 38846952 PMCID: PMC11153796 DOI: 10.3389/fimmu.2024.1410540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Psoriasis is a common, life-long skin disease with a significant negative health and societal impact. Data on rates of disease control and treatment strategies are lacking in Central and Eastern European countries. We aimed to describe the real-world disease severity, control, and treatment strategies for psoriasis in patients from Central and Eastern European countries. CRYSTAL (EUPAS36459) was a cross-sectional, retrospective study in adults (18-75 years) from Bulgaria, Estonia, Hungary, Latvia, Lithuania, Romania, and Russia. We enrolled patients with moderate-to-severe psoriasis receiving continuous systemic treatment for ≥24 weeks. We used the Psoriasis Area and Severity Index (PASI) to describe disease severity and the Dermatology Life Quality Index (DLQI) to assess quality of life (QoL) and collected other outcomes [psoriasis work productivity and activity impairment (WPAI-PSO), patient satisfaction] at enrollment. Analyses were descriptive. A total of 690 patients were included in the analyses. Median disease duration was 11.8 years. Current treatment was monotherapy for most patients (95.8%) with either biological (BIO group; 88.4%) or conventional (NON-BIO group; 7.4%) agents. Mean (± standard deviation) absolute PASI scores were 3.5 ± 5.7, 3.1 ± 5.3, and 6.6 ± 7.4 in the overall population, the BIO group, and the NON-BIO group, respectively. Among patients treated with monotherapy, absolute PASI scores ≤1, ≤3, and ≤5 were observed for 44.1%, 72.0%, and 82.6% of BIO patients and 21.6%, 33.3%, and 49.0% of NON-BIO patients. Mean DLQI total score was 3.3 ± 5.1; higher scores were noted for higher absolute PASI. The most impacted WPAI-PSO domain was presenteeism; for all domains, impact increased with increased absolute PASI. A total of 91.8% of BIO patients and 74.5% of NON-BIO patients were satisfied with the current treatment. We observed a better disease control in BIO than NON-BIO patients. However, around half of BIO patients did not reach clear skin status and reported an impact on QoL. An improvement in treatment strategies is still needed in Central and Eastern European countries to optimize outcomes of moderate-to-severe psoriasis.
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Affiliation(s)
- Liisi Raam
- Department of Dermatology and Venereology, University of Tartu, Dermatology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ilona Hartmane
- Department of Dermatology and Venereology, Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LSMU), Hospital of LSMU Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) Member, Kaunas, Lithuania
| | - Arfenya E. Karamova
- Dermatology Department, State Research Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Eniko Telegdy
- Dermatology Department, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Ivan Botev
- Ambulatory for Specialized Medical Care, Skin and Venereal Diseases, Sofia, Bulgaria
| | | | - Simone Rubant
- AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
| | | | - Maria Magdalena Constantin
- IInd Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Foley P, Mahar PD, Smith SD, Gupta M, Manuelpillai N, Orchard D, Wong LC, Su JC, James A, Fischer G, Marshman G, Rawlin M, Turner M, King E, Kennedy R, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Considerations for paediatric patients. Australas J Dermatol 2024. [PMID: 38741474 DOI: 10.1111/ajd.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Treatment goals have been established in Australia to facilitate the management of adults with moderate to severe psoriasis. The Australasian College of Dermatologists sought to determine if and how these adult treatment goals could be modified to accommodate the needs of paediatric and adolescent patients. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 23/29 statements in round 1 and 17/18 statements in round 2. There was a high level of concordance with treatment criteria in the adult setting. The limitations of applying assessment tools developed for use in adult patients to the paediatric setting were highlighted. Treatment targets in the paediatric setting should include objective metrics for disease severity and psychological impact on the patients and their family, and be based on validated, age-appropriate tools. CONCLUSION While the assessment, classification and management of moderate to severe psoriasis in paediatric patients aligns with metrics established for adults, it is vital that nuances in the transition from childhood to adolescence be taken into account. Future research should focus on psoriasis severity assessment scales specific to the paediatric setting.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D Mahar
- Skin Health Institute, Carlton, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Saxon D Smith
- Sydney Adventist Hospital Clinical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- The Dermatology and Skin Cancer Centre, St Leonards, New South Wales, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- The Skin Hospital, Westmead, New South Wales, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manuelpillai
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Barkers Road Dermatology, Kew, Victoria, Australia
| | - Li-Chuen Wong
- Royal Prince Alfred Hospital Medical Centre, Newtown, New South Wales, Australia
- Department of Dermatology, Children's Hospital, Westmead, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - John C Su
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amelia James
- Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gayle Fischer
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gillian Marshman
- Dermatology Clinic, Flinders Medical Centre, Adelaide, South Australia, Australia
- Willan House Dermatology, Brighton, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Morton Rawlin
- Macedon Medical Centre, Templestowe Lower, Victoria, Australia
| | | | - Emma King
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robyn Kennedy
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Thaçi D, Piaserico S, Gaarn Du Jardin K, Warren RB. Long-term stability of PASI <3 response to tildrakizumab: Pooled analyses from reSURFACE 1 and reSURFACE 2 phase 3 trials through 5 years. J Eur Acad Dermatol Venereol 2023; 37:e501-e504. [PMID: 36433779 DOI: 10.1111/jdv.18783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Diamant Thaçi
- Institute and Comprehensive Centre for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
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Nicolescu AC, Ionescu MA, Constantin MM, Ancuta I, Ionescu S, Niculet E, Tatu AL, Zirpel H, Thaçi D. Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122050. [PMID: 36556415 PMCID: PMC9785802 DOI: 10.3390/life12122050] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Psoriasis is not optimally controlled in spite of newly developed treatments, possibly due to the difficulty of objectively quantifying the disease's severity, considering the limitations of the clinical scores used in clinical practice. A major challenge addresses difficult-to-treat areas, especially in the absence of significant body surface involvement. It is controversial whether the severity evaluation of patients with several affected areas (having at least one difficult-to-treat area) should be done differently from current methods. Scores used for special areas (PSSI, NAPSI and ESIF) allow an accurate assessment of disease severity in difficult-to-treat areas, but the issue of whether to integrate these scores into PASI, BSA or DLQI remains. The review's purpose resides in providing an overview of the main current issues in determining psoriasis severity in patients with psoriasis in difficult-to-treat areas and suggesting possible solutions for the optimal integration of the area assessment in current scores: severity can be either established according to the highest calculated score (PASI or PSSI or NAPSI or ESIF) or by adding a correction factor in the calculation of PASI for special areas.
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Affiliation(s)
| | - Marius-Anton Ionescu
- Dermatology Department, University Hospital “Saint Louis”, University of Paris, 75014 Paris, France
| | - Maria Magdalena Constantin
- Department of Dermatology II, “Carol Davila” University of Medicine and Pharmacy, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Ioan Ancuta
- Department of Rheumatology, “Carol Davila” University of Medicine and Pharmacy, “Dr. I. Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania
- Department of Dermatology III, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (I.A.); (E.N.); Tel.: +40-728267435 (I.A.); +40-741398895 (E.N.)
| | - Sinziana Ionescu
- General Surgery and Surgical Oncology Clinic I of the Bucharest Oncology Institute, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania
- “Prof Dr. Al Trestioreanu” Bucharest Oncology Institute, 022328 București, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
- Pathology Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, 800578 Galati, Romania
- Correspondence: (I.A.); (E.N.); Tel.: +40-728267435 (I.A.); +40-741398895 (E.N.)
| | - Alin Laurentiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, “Sfanta Cuvioasa Parascheva” Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Henner Zirpel
- Research Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
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Montoya-Londoño D, Gómez-Mercado CA, Acevedo JIE, Cadavid JM, Segura A, Alzate NAG, Londoño AM. Therapeutic Failure In Moderate And Severe Psoriasis Patients In a Health Institution - a Transversal Study of Prevalence And Demographic Determinants. J DERMATOL TREAT 2022; 33:2821-2826. [PMID: 35583354 DOI: 10.1080/09546634.2022.2079597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psoriasis is a chronic disease that seriously impacts quality of life. There are known genetic and environmental factors that influence its onset and progression. Even though there is no cure for it, there are a variety of treatments available today to control its symptoms, although many of them fail to do so substantially. OBJECTIVE to identify the association of multiple sociodemographic, clinical, and pharmacological factors with therapeutic failure. METHODS observational, descriptive, cross-sectional, retrospective, and analytical study of therapeutic failure in patients with moderate or severe psoriasis between 2020 and 2021 was performed. RESULTS In total 1051 patients with moderate or severe psoriasis were evaluated. Gender (ORa: 0.579 CI95%: 0.382 - 0.878), type of therapy (biologic or non-biologic; ORa: 1.939 CI95%: 1.242 - 3.027), age (ORa: 1.018 CI95%: 1.003 - 1.034), days of treatment (ORa: 1 CI95%: 0.999 - 1) and DLQI (ORa: 1.212 CI95%: 1.172 - 1.253) are significantly associated with therapeutic failure. CONCLUSION Being male and receiving biologic therapy are associated with a higher incidence of therapeutic failure in the treatment of moderate or severe psoriasis. The increase in DLQI increase in the probability of failure, and mayor age or days of treatment decrease in the probability of failure.
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Affiliation(s)
| | | | | | | | - Angela Segura
- Epidemiology and Biostatistics Research Group. CES University, Medellin, Colombia
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