Symptom Control, Skin Clearance Relevant Outcomes in Patients With Psoriasis

Patients with psoriasis most often identified skin clearance and symptom control as the most important outcomes following treatment for the disease, according to a recent review published in JAMA Dermatology.

The researchers used MEDLINE, Embase, and Web of Science databases to look for studies published between August 1, 2019, and March 27, 2021, and 24 studies were included in their final anlaysis. Studies were excluded if they focused solely on psoriatic arthritis, had patients who were underage or unable to express beliefs, were interventional research, were published before 2003, were protocols of systematic reviews, concentrated on patient preferences or patient-reported outcomes, or were family- or caregiver-reported outcomes.

Quality assessments were done using the QUALSYST tool, and percentage scores were calculated for each study. Each response option, treatment goal, and treatment attribute were assigned to an outcome based on pattern recognition and taxonomy.

The 24 studies included 2 qualitative, 3 mixed-method, and 19 cross-sectional studies. Most of the studies were from Europe (14) and 23,317 patients were asked about the relevance of outcomes in management in psoriasis across all studies. The mean quality of the studies was 75.6% (range, 35.7%-100%). A total of 154 unique outcomes were collected from the literature covering the outcomes, with the most frequently used tool for assessing importance of outcomes being the Patient Benefit Index.

There were 23 outcomes within the core areas of physical/clinical, life impact, resource use, and adverse effects that were identified as relevant to patients. Skin clearance was the most frequently reported outcome (79.2%), followed by symptom control (70.8%) and treatment safety (62.5%). Comorbidity control and cost for society (4.2% each) were less frequently reported.

Differences in treatment goals were observed when gender, age, and treatment were considered. Patients younger than 65 years rated some aspects of their social life, such as “having a normal work life” and “having a normal sex life," as more important than older patients. Older patients valued sleeping better and having fewer adverse effects as more important.

Female patients also had higher expectations from treatment and valued items when it came to appearance compared with male patients. Patients who achieved clear skin also valued maintenance and achievement of the outcome higher than those who had not achieved either outcome.

Limitations to this study include the possibility that some literature was overlooked due to the heterogeneity of outcomes and different wording or interpretation given by authors, studies not covered by the 3 databases could have been missed, and excluding articles that had no subanalysis of patients could have excluded PsA outcomes that weren’t relevant to the research.

The researchers concluded that their review identified 23 unique outcomes that were relevant to patients. “The results of this systematic review may aid in the transition to a value-based approach because identifying which outcomes to measure is an important first step in defining value,” they wrote.

Reference

Hilhorst N, Deprez E, Pauwels N, Grine L, Lambert J, Hoorens I. Patient relevant outcomes in psoriasis a systematic review. JAMA Dermatol. Published online June 8, 2022. doi:10.1001/jamadermatol.2022.1756