IMPROVING THE CLASSIFICATION OF PSORIASIS SEVERITY
The current clinical definitions of psoriasis severity are narrowly defined and overlook the unique challenges faced by each patient, which may include localized lesions in specific areas and/or comorbidities. A more specific clinical severity classification is needed and would guide clinical decision-making to be more practical, meaningful, and better aligned with the true severity of a patient’s disease; strengthen psoriasis treatment guidelines and guide future clinical trials of drugs targeting various severities of psoriasis.
In Phase I of the project, the Delphi method was used to come to consensus, among IPC’s network of key opinion leaders, on a definition for each category of disease severity. As the result of the reclassification Delphi, IPC recommends that patients be considered a candidate for topical-only therapy or a candidate for systemic therapy.
In Phase II of the project, the working group is focusing on implementing studies that quantify the statement in real-world practice. In addition, significant work is being done to educate clinicians and patients on the new classification. Future work in Phase II will focus on educating regulatory bodies and developing additional activities to educate clinicians and patients.
PSORIASIS SEVERITY: COMMONLY USED CLINICAL THRESHOLDS MAY NOT ADEQUATELY CONVEY PATIENT IMPACT
|Golbari NM, van der Walt JM, Blauvelt A, Ryan C, van de Kerkhof P, Kimball AB. J Eur Acad Dermatol Venereol. 2020 Sep 25. doi: 10.1111/jdv.16966.|
RECATEGORIZATION OF PSORIASIS SEVERITY: DELPHI CONSENSUS FROM THE INTERNATIONAL PSORIASIS COUNCIL
Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, Blauvelt A. Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/ j.jaad.2019.08.026.
Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, due to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be mis-categorized, which can lead to under-treatment of psoriasis.
To develop a consensus statement on the classification of psoriasis severity.
A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity.
After completion of the exercise, seven severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: 1) BSA > 10%, 2) Disease involving special areas, 3) Failure of topical therapy.
This effort might have suffered from a lack of representation by all relevant stakeholders, including patients.
The consensus statement describes two categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.