Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council - 04/11/19

Doi : 10.1016/j.jaad.2019.08.026

Bruce Strober, MD, PhD ^a,^b,^⁎ , Caitriona Ryan, MD ^c, Peter van de Kerkhof, MD, PhD ^d, Joelle van der Walt, PhD ^d,^⁎ , Alexa B. Kimball, MD, MPH ^e, Jonathan Barker, MD, FRCP, FRCPath ^f, Andrew Blauvelt, MD, MBA ^g
on behalf of
International Psoriasis Council Board Members and Councilors
Marc Bourcier, Andre Carvalho, Arnon Cohen, Peter Foley, Colby Evans, Paolo Gisondi, Chris Griffiths, Mahira Hamdy El-Sayed, Cristina Eschevarria, Andrew Finlay, Robert Kalb, Craig Leonardi, Chuck Lynde, Ruth Murphy, Masamoto Murakami, Yukari Okubo, Errol Prens, Lluís Puig, Marieke Seyger, Lone Skov, Tadashi Terui, Fernando Valenzuela, Nicole Ward, Jashin Wu, Min Zheng

^a Yale University School of Medicine, New Haven, Connecticut
^b Central Connecticut Dermatology, Cromwell, Connecticut
^c Blackrock Clinic Dublin and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
^d International Psoriasis Council, St Louis, Missouri
^e Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
^f St John's Institute of Dermatology, King's College London, London, United Kingdom
^g Oregon Medical Research Center, Portland, Oregon

^∗Reprint requests: Joelle van der Walt, PhD.^∗Correspondence to: Bruce E. Strober, MD, PhD, Central Connecticut Dermatology, 1 Willowbrook Rd, Ste #2, Cromwell, CT 06416.Central Connecticut Dermatology1 Willowbrook Rd, Ste #2CromwellCT06416

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Abstract

Background

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, owing 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 miscategorized, which can lead to undertreatment of psoriasis.

Objective

To develop a consensus statement on the classification of psoriasis severity.

Methods

A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity.

Results

After completion of the exercise, 7 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) body surface area >10%, (2) disease involving special areas, and (3) failure of topical therapy.

Limitations

This effort might have suffered from a lack of representation by all relevant stakeholders, including patients.

Conclusion

The consensus statement describes 2 categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.

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Key words : BSA, psoriasis, severity, systemics, topicals

Abbreviations used : BSA, DLQI, IPC, PASI, PDI, PGA

Plan

Funding sources: None.

Conflicts of interest: Dr Strober has acted as a consultant and received honoraria from AbbVie, Almirall, Amgen, Arena, Boehringer Ingelheim, Bristol-Myers-Squibb, Celgene, Dermavant, Dermira, Janssen, LEO Pharma, Eli Lilly, Medac, Meiji Seika Pharma, Sebela Pharmaceuticals, Menlo Therapeutics, Novartis, Pfizer, GlaxoSmithKline, UCB Pharma, Sirtris, Sun Pharma, Ortho Dermatologics/Valeant, Regeneron, and Sanofi-Genzyme. Dr Strober has served as investigator (no direct payments made to Dr Strober) for AbbVie, Celgene, Eli Lilly, Janssen, Merck, Boehringer Ingelheim, GlaxoSmithKline, Pfizer, Galderma, and Sienna. Dr Strober has received consulting fee as Scientific Director for the Corrona Psoriasis Registry and grant support to the University of Connecticut for Fellowship Program (payments to the University of Connecticut, not Dr Strober) from AbbVie, Janssen, and the National Psoriasis Foundation. Dr Ryan has received compensation as a speaker, consultant, or advisor for AbbVie, Boehringer Ingelheim, Dermira, Dr Reddys, Janssen, LEO Pharma, Lilly, Novartis, Regeneron-Sanofi, and UCB. Dr van de Kerkhof received fees for consultancy service or lectureships from Celgene, Allmirall, AbbVie, Eli Lilly, Novartis, Jansen Pharmaceutica, LEO Pharma, Bristol-Myers Squib, and Dermavant. Dr Kimball has received compensation as a consultant and an investigator for Novartis, AbbVie, UCB, Lilly, and Janssen and has received fellowship funding from Janssen and AbbVie. Dr Kimball is a consultant to Amirall and shareholder and consultant to BMS. Dr Barker has served as an advisory board member and received honoraria from AbbVie, Almirall, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, LEO Pharma, Samsung, Sienna Bio, Sun Pharma, and UCB and has received research grant funding from Pfizer. Dr Blauvelt has served as a scientific adviser and/or clinical study investigator for AbbVie, Aclaris, Akros, Allergan, Almirall, Amgen, Arena, Athenex, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermavant, Dermira, Inc, Eli Lilly, FLX Bio, Galderma, Genentech/Roche, GlaxoSmithKline, Janssen, LEO Pharma, Meiji, Merck Sharp & Dohme, Novartis, Pfizer, Purdue Pharma, Regeneron, Revance, Sandoz, Sanofi, Genzyme, Sienna Pharmaceuticals, Sun Pharma, UCB Pharma, Valeant, and Vidac, and as a paid speaker for AbbVie, Regeneron, and Sanofi Genzyme. Dr van der Walt has no conflicts of interest to declare.