Redefining the therapeutic objective in psoriatic patients candidates for biological therapy

Abstract

The advances in psoriasis management currently allow achieving a good control of the disease. In particular, with the latest developed molecules, available evidence suggests that it is possible to pose an ambitious therapeutic goal, such as a Dermatology Life Quality Index 0/1, a Physician Global Assessment 0/1, or a Psoriasis Area and Severity Index 90/100 response. However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life. To optimize the treatment of psoriasis, it is not enough to define precisely the therapeutic objective, but also to adapt the therapeutic strategy to make the necessary modifications in case of not achieving it at the time point (at the end of the induction phase, or every 3–6 months) to be agreed with the patient (the so-called treat-to-target approach). In the present report, based on the Delphi methodology, 11 dermatologists from the Spanish Psoriasis Group addressed key issues that could be involved in the achievement and maintenance of the therapeutic goals of patients with moderate to severe psoriasis. The document provides 27 consensus statements intended to support clinical decision-making by healthcare professionals for patients who might be candidates to receive biologic therapy.

Keywords:

• Psoriasis
• treat-to-target strategy
• biological therapy
• therapeutic objective
• PASI
• absolute PASI
• DLQI

Acknowledgements

The authors would like to acknowledge Anabel Herrero, who provided writing support on behalf of Springer Healthcare, with funding from Novartis. The funder had no involvement in the writing of this manuscript but did review for medical accuracy prior to submission.

Disclosure statement

G. Carretero served as a consultant for Abbvie, Janssen, MSD, and Pfizer; gave expert testimony for Abbott Laboratories, MSD, Pfizer, Janssen, Leo-Pharma, Novartis, Celgene, and Lilly; has participated as investigator in clinical trials of Abbvie, Janssen, MSD, Pfizer, Lilly, and Novartis; received grants from Abbvie, Janssen, MSD, and Pfizer and equipment from MSD and Pfizer. L. Puig has received institutional grants/research support from Abbvie, Amgen, Janssen, Lilly, Novartis, and Pfizer; honoraria or consultation fees from Abbvie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Centocor, Gebro, Janssen, Leo-Pharma, Lilly, Merck-Serono, MSD, Novartis, Pfizer, and Sandoz; and has served as a speaker for Celgene, Janssen, MSD, Novartis, and Pfizer. J.M. Carrascosa has received institutional grants/research support from AbbVie, Novartis, honoraria or consultation fees from Abbvie, Almirall, Amgen, Biogen, Celgene, Gebro, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer and has served as a speaker for Celgene, Lilly, Janssen, Novartis, Abbvie, Gebro, Biogen, and Pfizer. L. Ferrándiz has participated as investigator in clinical trials sponsored by Amgen, Lilly, Novartis; has received honoraria or consultation fees from MSD, Abbvie, Amgen, Novartis, Lilly, Leo Pharma, and Almirall. R. Ruiz-Villaverde has participated as invited speaker and received honoraria or consultation fees from Abbvie, Novartis, Cellgene, Pfizer, Janssen, and Lilly. P. De la Cueva served as a consultant, received honoraria, participated in speaker´s bureaus or received grants from Almirall, Biogen, Boehringer, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and UCB. I. Belinchon acted as a consultant for Pfizer; Janssen, MSD, Almirall, Lilly, and Leo-Pharma, and as an invited speaker for AbbVie, Pfizer, Janssen, Novartis, and MSD. E. Vilarrasa has participated as invited speaker and received honoraria or consultation fees from MSD, Abbvie, Novartis, Celgene, Pfizer, Janssen, Lilly, and UCB. R. Del Rio has participated as investigator in clinical trials sponsored by Novartis and Abbvie and has received honoraria or consultation fees from Janssen and Abbvie. J.L. Sánchez-Carazo has received institutional grants/research support from AbbVie, Novartis, honoraria or consultation fees from AbbVie, Almirall, Amgen, Biogen, Celgene, Gebro, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer and has served as a speaker for Celgene, Lilly, Janssen, Novartis, Abbvie, Gebro, Biogen, and Pfizer. A. López-Ferrer has participated as invited speaker and received honoraria or consultation fees from MSD, Abbvie, Novartis, Celgene, Pfizer, Janssen, Lilly, and UCB. F. Peral has participated as invited speaker and received honoraria or consultation fees from MSD, Abbvie, Novartis, Celgene, Pfizer, and Janssen. S. Armesto acted as a consultant for Pfizer; Janssen, MSD, Almirall, Lilly, and Leo-Pharma, and as an invited speaker for Abbvie, Pfizer, Janssen, Novartis, and MSD. N. Eiris has participated in clinical trials sponsored by Novartis; and served as an invited speaker for Abbvie, Pfizer, Janssen, Novartis, Leo Pharma, and Almirall. J. Mitxelena has participated as investigator in clinical trials sponsored by Novartis; and has served as a speaker and received honoraria or consultation fees from Abbvie and Celgene. J. Vilar has participated as invited speaker and received honoraria or consultation fees from MSD, Abbvie, Novartis, Celgene, Pfizer, and Janssen. M. Ara has received honoraria as a consultant, investigator, speaker or advisory board member from Abbvie, Amgen, Celgene, Janssen, Leo Pharma, MSD, Novartis, and Pfizer. C. Soria has participated as invited speaker and received honoraria or consultation fees from Pfizer, Abbvie, Janssen, Leo-Pharma and Novartis.

Funding

Novartis Lab. has sponsored this project by request of the Spanish Psoriasis Group. Novartis is the sole sponsor for this project and provided funding to invited participants, including honoraria for the development of the survey and attendance to the meetings and reimbursement for travel to the meetings. Novartis provided funding to a third-party vendor (Springer-Nature) for logistical support at the meetings, survey development and preparation of a basic report from the survey data. Novartis personnel attended the meetings to provide logistical support but did not give input to the survey development. Novartis was not involved in the development of the manuscript but did have an opportunity to review the final manuscript draft. The final manuscript content was determined by the scientific committee formed by 5 clinical dermatologists (GC, LP, JMC, LF, RrV, PdelaC, IB). No payments were made to the authors for the development of this manuscript.