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From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis - 18/04/17

Doi : 10.1016/j.jaad.2016.10.017 
April W. Armstrong, MD, MPH a, , Michael P. Siegel, PhD b, Jerry Bagel, MD c, d, Erin E. Boh, MD, PhD e, Megan Buell b, Kevin D. Cooper, MD f, Kristina Callis Duffin, MD, MS g, Lawrence F. Eichenfield, MD h, Amit Garg, MD i, Joel M. Gelfand, MD, MSCE j, Alice B. Gottlieb, MD, PhD k, John Y.M. Koo, MD l, Neil J. Korman, MD, PhD f, Gerald G. Krueger, MD g, Mark G. Lebwohl, MD m, Craig L. Leonardi, MD n, Arthur M. Mandelin, MD, PhD o, M. Alan Menter, MD p, Joseph F. Merola, MD, MMSC q, David M. Pariser, MD r, s, Ronald B. Prussick, MD, FRCP t, Caitriona Ryan, MD p, Kara N. Shah, MD u, Jeffrey M. Weinberg, MD m, MaryJane O.U. Williams, MD a, Jashin J. Wu, MD v, Paul S. Yamauchi, MD, PhD w, Abby S. Van Voorhees, MD r
a Keck School of Medicine, University of Southern California, Los Angeles, California 
b National Psoriasis Foundation, Portland, Oregon 
c Windsor Dermatology, East Windsor, New Jersey 
d University Medical Center of Princeton at Plainsboro, Plainsboro, New Jersey 
e Tulane University School of Medicine, New Orleans, Louisiana 
f University Hospitals Case Medical Center, Cleveland, Ohio 
g University of Utah School of Medicine, Salt Lake City, Utah 
h University of California, San Diego School of Medicine, La Jolla, California 
i Northwell Health and Hofstra North Shore University Hospital, Long Island Jewish Medical Center School of Medicine, Manhasset, New York 
j University of Pennsylvania, Philadelphia, Pennsylvania 
k Tufts University School of Medicine, Boston, Massachusetts 
l University of California San Francisco Medical Center, San Francisco, California 
m Icahn School of Medicine at Mount Sinai, New York, New York 
n St Louis University Medical School, St Louis, Missouri 
o Northwestern University Feinberg School of Medicine, Chicago, Illinois 
p Baylor University Medical Center and Texas A&M Health Science Center, Dallas, Texas 
q Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 
r Eastern Virginia Medical School, Norfolk, Virginia 
s Virginia Clinical Research Inc, Norfolk, Virginia 
t George Washington University, Washington, District of Columbia 
u Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 
v Kaiser Permanente Los Angeles Medical Center, Los Angeles, California 
w Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 

Correspondence to: April W. Armstrong, MD, MPH, Keck School of Medicine, University of Southern California, Los Angeles, Office of the Dean, KAM 510, 1975 Zonal Ave, Los Angeles, CA 90089.Keck School of MedicineUniversity of Southern California, Los AngelesOffice of the DeanKAM 5101975 Zonal AveLos AngelesCA90089

Abstract

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 more 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.

Le texte complet de cet article est disponible en PDF.

Key words : biologics, body surface area, outcome measures, Physician Global Assessment, psoriasis, systemic therapies, treat to target, treatment, treatment goals

Abbreviations used : BSA, DLQI, NPF, PASI, PGA


Plan


 Dr Gottlieb is currently affiliated with New York Medical College, Valhalla, New York.
 Funding for this study was provided by the National Psoriasis Foundation. The National Psoriasis Foundation participated in the interpretation of data and review and approval of the manuscript. Dr Gelfand is supported by National Institutes of Health grant K24 AR064310.
 Disclosure: Dr Armstrong has served as an investigator and/or advisor to AbbVie, Amgen, Celgene, Janssen, Merck, Eli Lilly, Novartis, and Pfizer. Dr Siegel is employed by the National Psoriasis Foundation, which receives unrestricted financial support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, and Pfizer. Dr Bagel has served as an advisory board member and/or speaker for AbbVie, Eli Lilly, Novartis, Celgene, Boehringer Ingelheim, and Amgen. Dr Boh has served as an investigator and/or advisor to AbbVie, Amgen, Janssen Biotech, Regeneron, Celgene, Novartis, Novan, and Eli Lilly. Ms Buell has served as an intern for the National Psoriasis Foundation. Dr Cooper has served as an advisory member and/or consultant for Seattle Genetics and Thesan Pharmaceuticals. Dr Callis Duffin has served as investigator and/or consultant for Amgen, AbbVie, Novartis, Janssen, Eli Lilly, Celgene, Pfizer, Stiefel, and Bristol Myers Squibb. Dr Eichenfield has served as an investigator for Galderma, LEO Pharma, and Stiefel and a consultant and/or speaker for Amgen, Celgene, Eli Lilly, Janssen, and Valeant. Dr Garg has served on the advisory board for Eli Lilly, Pfizer, and Bristol Myers Squibb. Dr Gelfand served as a consultant for AbbVie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen, Sanofi, Merck, Novartis, Valeant, and Pfizer, receiving honoraria; receives research grants (to the Trustees of the University of Pennsylvania) from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer; received payment for continuing medical education work related to psoriasis; and is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma. Dr Gottlieb serves as an advisor for Amgen, Astellas, Akros, Janssen, Celgene, Bristol Myers Squibb, Beiersdorf, AbbVie, TEVA, Actelion, UCD, Novo Nordisk, Novartis, Dermipsor, Incyte, Pfizer, Canfite, Eli Lilly, Coronado, Vertex, Karyopharm, CSL Behring Biotherapies for Life, Glaxo Smith Kline, Xenoport, Catabasis, Meiji Seika Pharma Co, Takeda, Mitsubishi, Tanabe Pharma Development America, Genentech, Baxalta, Kineta One, and KPI Therapeutics, and received research grants (paid to Tufts Medical Center) from Janssen, AbbVie, Amgen, Novartis, Pfizer, Eli Lilly, Levia, Merck, Xenoport, Dermira, and Baxalta. Dr Koo serves as a consultant, advisor, and/or speaker for Novartis, AbbVie, Celgene, LEO Pharma, Valeant, Pfizer, and Photomedex. Dr Korman serves as an investigator for AbbVie, Celgene, Eli Lilly, Janssen, Merck, and Pfizer and serves as an advisor and/or speaker for AbbVie, Celgene, Eli Lilly, Immune Pharm, Janssen, Novartis, and Pfizer. Dr Krueger serves as a consultant of advisory board member for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Genentech, Janssen, Eli Lilly, L'Oreal, Novartis, Pfizer, UCB, and Valeant. Dr Lebwohl is an employee of the Mount Sinai Health System, which receives funds from AbGenomics, Amgen, Anacor, Boehringer Ingelheim, Celgene, Ferndale, Eli Lilly, Janssen, Kadmon, LEO Pharma, MedImmune, Novartis, Pfizer, Sun Pharmaceuticals, and Valeant. Dr Leonardi serves as an advisor and/or investigator for Actavis, AbbVie, Amgen, Boehringer Ingelheim, Celgene, Coherus, Corrona, Dermira, Eli Lilly, Galderma, Janssen, Merck, Pfizer, Sandoz, Stiefel, LEO Pharma, Novartis, Wyeth, UCB, and Vitae and serves on the speaker bureau for AbbVie, Celgene, Novartis, and Eli Lilly. Dr Mandelin serves as a speaker for AbbVie, Genentech, Pfizer, and UCB. Dr Menter serves as an investigator for AbbVie, Allergen, Amgen, Anacor, Boehringer Ingelheim, Celgene, Dermira, Eli Lilly, Janssen, LEO Pharma, Merck, Neothetics, Novartis, Pfizer, Regeneron, Symbio/Maruho, and Xenoport; he serves as an advisor and/or speaker for AbbVie, Allergen, Amgen, Boehringer Ingelheim, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Vitae, and Xenoport. Dr Merola serves as an investigator for Boehringer Ingelheim, and an advisor for Mallinckrodt, AbbVie, Eli Lilly, Novartis, Pfizer, and Janssen. Dr Pariser serves as an advisor and/or investigator for Bickel Biotechnology, Biofrontera AG, Celgene, Dermira, DUSA Pharmaceuticals, LEO Pharma, Novartis, Pfizer, Regeneron, Valeant, Abbott, Amgen, Eli Lilly, Novo Nordisk, Ortho Dermatologics, Peplin, Photocure, Stiefel, and Valeant. Dr Prussick serves as an investigator for Novartis and an advisor and/or speaker for AbbVie, Celgene, and Janssen. Dr Ryan serves as an advisor and/or speaker for AbbVie, Eli Lilly, Novartis, Boehringer Ingelheim, and Regeneron. Dr Shah serves as an investigator for Galderma. Dr Weinberg serves as investigator for Novartis, Boehringer Ingelheim, and LEO Pharma and serves as a speaker and/or advisor for Novartis, Eli Lilly, Celgene, AbbVie, Amgen, and LEO Pharma. Dr Wu received research funding from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Coherus Biosciences, Dermira, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, Sandoz, and Sun Pharmaceutical Industries; he is a consultant for AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Pfizer, Regeneron, and Sun Pharmaceutical Industries. Dr Yamauchi has served as an investigator for Amgen, Celgene, Dermira, Galderma, Janssen, LEO Pharma, Eli Lilly, MedImmune, Novartis, Pfizer, Regneron, and Sandoz; he serves as an advisor and/or speaker for AbbVie, Amgen, Baxter, Celgene, Dermira, Galderma, Janssen, LEO Pharma, Eli Lilly, Novartis, Pfizer, and Regeneron. Dr Van Voorhees serves as an advisor for Novartis, Celgene, Pfizer, Aqua, Dermira, Astra Zeneca, AbbVie, Valeant, Merck, Corrona, Janssen, Amgen, and LEO Pharma. Dr Williams has no conflicts of interest to declare.
 Reprints not available from the authors.


© 2016  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 76 - N° 2

P. 290-298 - février 2017 Retour au numéro
Article précédent Article précédent
  • Impact of childhood psoriasis on parents of affected children
  • Megha M. Tollefson, Dawn M. Finnie, Jennifer J. Schoch, David T. Eton
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  • Ignacio Garcia-Doval, Arnon D. Cohen, Simone Cazzaniga, Ilan Feldhamer, Antonio Addis, Gregorio Carretero, Carlos Ferrándiz, Robert S. Stern, Luigi Naldi, Psonet Network

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