A Treat-to-Target Outcome for Psoriasis Management Set by Expert Committee, Patients

Psoriasis Hand
“Psoriasis Hand, white background.Photographed with Canon EOS 5D Mark II in RAW 16bit and Adobe RGB and professional processed.”
With this novel T2T composite outcome for psoriasis, clinicians and patients can participate in shared decisions on psoriasis treatment goals that can serve as guidance for future treatment steps, -leading to improved management of the disease.

A panel of key opinion leaders, expert dermatologists, and patients have developed a treat-to-target (T2T) strategy outcome for the management of psoriasis, which has been published in the Journal of the European Academy of Dermatology and Venereology.

To determine a definition for T2T outcome for moderate to severe psoriasis, researchers first performed a literature review and conducted 5 discussions on these findings with key opinion leaders. Biologic-experienced dermatologists were recruited, a survey was developed based on consensus statements, and a total of 3 eDelphi survey rounds and a psoriasis patient focus group were employed.

The panel set the T2T outcome for psoriasis under the assumption that the patient and dermatologist were participating in shared decision making. In addition, the T2T outcome was set assuming that the dermatologist was aware and referred patients for comorbidities and that the patient adhered to treatment appropriately.

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Several components of the T2T outcome were identified, including a change greater than or equal to Psoriasis Area Severity Index 90/75 or Physician Global Assessment ≤1, itch visual analogue scale (VAS) score ≤1, absence of disturbing lesions, Dermatology Life Quality Index ≤1/3, incapacity daily functioning VAS score ≤1, safety ≤ mild side effects, and full/mild treatment tolerability.

Based on discussions between experts and the patient focus group, the consensus on the time to achieve the T2T outcome was 12 weeks following the start of all treatments. Panel members agreed that safety should never exceed the presence of mild adverse events, regardless of the point in time of the patient’s treatment journey.

Study limitations include the lack of data on minimal clinical difference, responsiveness, and validity.

The researchers wrote that the introduction of “the target-to-treat concept in psoriasis is the next logical step in the management of this chronic skin disease.”

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Grine L, de la Brassinne M, Ghislain PD, et al. A Belgian consensus on the definition of a treat-to-target outcome set In psoriasis management [published online November 20, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16104