Quality of Life Perceptions Correlate with PASI Score Reductions Among Psoriasis Patients

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Patients with moderate to severe plaque psoriasis given interleukin (IL)-17 or 23 inhibitors may adequately achieve target Dermatology Life Quality Index (DLQI) scores recommended by clinical guidelines, according to new findings, suggesting the possibility of implementing patient-reported outcomes in clinical assessments of treatment efficacy.¹

These results represented the conclusion of new research conducted to evaluate the effectiveness in quality of life terms—as perceived by adults with psoriasis—treated with IL-17 or 23 inhibitors. The investigators, led by Bárbara Anguita-Montenegro of the Servicio de Farmacia, Hospital General Universitario de Ciudad Real in Spain, sought to identify associated factors.

Anguita-Montenegro and colleagues noted that in the field of dermatology, DLQI is the most implemented tool for evaluating patients’ quality of life.²

“The main objective of this study was to determine the effectiveness of IL-17 and IL-23 inhibitors in adult patients with (moderate-to-severe psoriasis) using patient-reported (quality of life) and disease severity as assessed by the PASI after at least 12 or 16 weeks of treatment, respectively,” Anguita-Montenegro and colleagues wrote.¹

Background and Methods

A cross-sectional trial design was used by the research team, with the study done from November 2021 - April 2022 and adult patients with diagnoses of moderate to severe plaque psoriasis recruited. These participants had to have been undergoing IL-17 inhibitor (ixekizumab, secukinumab, and brodalumab) or IL-23 inhibitor (guselkumab and risankizumab) therapy for at least 12 and 16 weeks, respectively.

The team gathered data on participants such as their treatment history, comorbidities, demographics, and treatment efficacy based upon quality of life and PASI scores. The latter factor was evaluated through DLQI scores and impacted dimensions. Each of these elements, excluding subjects’ DLQI scores, were drawn from electronic medical records.

The investigators calculated the Medication Possession Ratio (MPR) to assess treatment adherence. MPR is the number of days a treatment was dispensed versus the number of days involved in the period of study.

The research team looked at DLQI scores through the use of participant interviews during the dispensing process at pharmacy care clinics. Telephone questionnaires were utilized among those who had not gotten their medication in person during the study period.

Ten questions within the DLQI assessed subjects’ views of their psoriasis’s impact over the previous week, with responses range on a 4-point Likert scale. Dimensions such as perceptions and symptoms (questions 1–2), activities each day (3–4), participants’ leisure (5–6), work/study (7), interpersonal relationships including sexuality (8–9), and therapies (10), were used.

Psoariasis area severity index (PASI) was implemented by the investigators to assess lesion severity using 4 clinical parameters: erythema, itch, scaling, and induration. Scores reported for each body region's severity parameters were also multiplied by the area estimate and a weight factor. A P-value of < .05 was noted as statistically significant, with confidence intervals presented at the 95% level (CI 95%).

Findings

There were 41 participants included, with 65% being male and a median age of 54 years noted by the research team. The team found that treatment among these subjects included brodalumab for 15%, guselkumab for 25%, ixekizumab for 35%, secukinumab for 17.5%, and risankizumab for 7.5%.

PASI reductions were identified by the investigators among 94.6% (interquartile range 76.8–100%), with the team noting a DLQI score of 1 among 60% participants. The areas most affected in terms of health dimensions were shown to be symptoms and perceptions (57.5%), activities each day (27.5%), and treatment-associated discomfort (17.5%).

A notable finding of the research team was a lack of correlation identified between subjects’ DLQI scores under 1 and comorbidities, demographic factors, or treatment specifics. Additionally, the team reported that median reduction in PASI score among participants that had a DLQI score below 1 had surpassed that of those with a DLQI score over 1 (100% versus 90.2%, P = .025).

“As mentioned above, the limitations of the study include those related to the DLQI and its narrow time frame,” they wrote. “Therefore, we recommend that future studies employ a variety of tools to assess effectiveness simultaneously. Furthermore, the responses to certain questions, such as those concerning sexuality, may have been influenced by the method of questionnaire completion (i.e. in person or by telephone).”

References

1. ^{Anguita-Montenegro B, Areas-Del Águila VL, Palacios-Moya E, García-Arpa M, Sánchez-Caminero MP, Luque-Jiménez M. Perceived quality of life in patients with psoriasis treated with interleukin 17 and 23 inhibitors. Farm Hosp. 2024 Feb 28:S1130-6343(24)00016-3. English, Spanish. doi: 10.1016/j.farma.2024.01.004. Epub ahead of print. PMID: 38423945.}
2. ^{J.M. Carrascosa, L. Puig, I. Belinchón, L. Salgado-Boquete, E. del Alcázar, J.J. Andrés Lencina, et al. Actualización práctica de las recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPS) para el tratamiento de la psoriasis con terapia biológica. Parte 1. Conceptos y manejo general de la psoriasis con terapia biológica Actas Dermo-Sifiliogr, 113 (3) (2022), pp. 261-277, 10.1016/j.ad.2021.10.003.}