Symptom Control, Skin Clearance Relevant Outcomes in Patients With Psoriasis

A systematic review found that skin clearance, symptom control, and treatment safety were among the most anticipated outcomes of the treatment of patients with psoriasis.

According to a recent review published in JAMA dermatology.

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

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

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

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 commonly reported outcome (79.2%), followed by symptom control (70.8%) and treatment safety (62.5%). Comorbidity control and costs to society (4.2% each) were reported less frequently.

Differences in treatment goals were observed when gender, age and treatment were considered. Patients under the age of 65 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 rated better sleep and fewer adverse effects as more important.

Female patients also had higher treatment expectations and valued items when it came to appearance compared to male patients. Patients who achieved clear skin also rated maintenance and outcome attainment higher than those who achieved neither outcome.

Limitations of this study include the possibility that some literature was overlooked due to the heterogeneity of the outcomes and different wording or interpretation given by authors, studies not included in the 3 databases could have been missed and the exclude articles that could not have had patient subanalysis. excluded PsA results not relevant to the study.

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 values-based approach, as identifying the outcomes to be measured 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

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