From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis

April W. Armstrong, MD, MPHPress enter key for correspondence informationPress enter key to Email the author

, 

Michael P. Siegel, PhD

, 

Jerry Bagel, MD

, 

Erin E. Boh, MD, PhD

, 

Megan Buell

, 

Kevin D. Cooper, MD

, 

Kristina Callis Duffin, MD, MS

, 

Lawrence F. Eichenfield, MD

, 

Amit Garg, MD

, 

Joel M. Gelfand, MD, MSCE

, 

Alice B. Gottlieb, MD, PhD

, 

John Y.M. Koo, MD

, 

Neil J. Korman, MD, PhD

, 

Gerald G. Krueger, MD

, 

Mark G. Lebwohl, MD

, 

Craig L. Leonardi, MD

, 

Arthur M. Mandelin, MD, PhD

, 

M. Alan Menter, MD

, 

Joseph F. Merola, MD, MMSC

, 

David M. Pariser, MD

, 

Ronald B. Prussick, MD, FRCP

, 

Caitriona Ryan, MD

, 

Kara N. Shah, MD

, 

Jeffrey M. Weinberg, MD

, 

MaryJane O.U. Williams, MD

, 

Jashin J. Wu, MD

, 

Paul S. Yamauchi, MD, PhD

, 

Abby S. Van Voorhees, MD

Open Access

DOI: http://dx.doi.org/10.1016/j.jaad.2016.10.017

Article Info

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Background

An urgent need exists in the United States to establish treatment goals in psoriasis.

Objective

We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice.

Methods

The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre-Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds.

Results

A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or less from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less.

Limitations

Although BSA is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side effects.

Conclusion

With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.