Psoriasis treatment goals, systemic therapy yield greatest QOL improvement

A 90% reduction in Psoriasis Area Severity Index and a 90% decrease in body surface area may help pediatric patients with psoriasis reach optimal quality of life, according to findings published in JAMA Dermatology.

“Systemic treatments are associated with a greater degree of improvement of quality of life compared with topical treatments independent of PASI response,” Finola M. Bruins, MD, of the department of dermatology at Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues wrote.

In the single-center study, researchers evaluated data on 319 patients younger than 18 years with psoriasis (median age, 10 years; 57.4% girls) from the Child-CAPTURE registry who attended the outpatient clinic in Nijmegen, the Netherlands, from September to May 2018.

To evaluate the association between PASI, body surface area (BSA) and quality of life (QOL), the Children’s Dermatology Life Quality Index (CDLQI) score was collected for each patient at every visit.

Treatments were clustered into topical, dithranol, conventional systemic and biological treatments. UV-B phototherapy was not assessed in this study. A treatment episode was defined as the period from the start to the end of treatment or follow-up, according to researchers. In systematic therapy, researchers considered episodes with treatment interruptions of up to 90 days as continuous episodes.

Improvement in the CDLQI score was associated with higher PASI and BSA.

Results showed QOL improvement in patients with higher PASI responses and BSA involvement. Patients with a PASI 90 or greater and a decrease in BSA of 90% had the highest significant CDLQI improvement in this study.

“These findings suggest that a PASI 90 or greater and a decrease in BSA involvement of at least 90% may be clinically meaningful treatment goals that will help pediatric patients with psoriasis reach optimal QOL,” the researchers wrote. – by Erin T. Welsh

Disclosures: Bruins reports she received grants from Eli Lilly and Co. and performed clinical trials for Eli Lilly and Co., Janssen, Leo Pharma and Pfizer. Please see the study for all other authors’ relevant financial disclosures.