Original article
Patient-reported outcomes for psoriasis patients with clear versus almost clear skin in the clinical setting

https://doi.org/10.1016/j.jaad.2014.05.001Get rights and content

Background

There is little evidence to guide the establishment of treatment goals for moderate to severe psoriasis in the clinical setting.

Objective

We sought to compare Dermatology Life Quality Index scores and prescription topical medication use between patients with clear versus almost clear skin.

Methods

This was a multicenter cross-sectional study of 97 patients with clear skin and 441 patients with almost clear skin receiving current systemic therapy or phototherapy for a primary indication of plaque psoriasis evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network.

Results

In adjusted analyses, patients with clear versus almost clear skin were more likely to report no impact of psoriasis on quality of life (relative risk 1.60; 95% confidence interval 1.37-1.86). Patients with clear versus almost clear skin were also more likely to report no prescription topical medication use in the preceding week (relative risk 2.08; 95% confidence interval 1.73-2.49).

Limitations

Cross-sectional design prohibits longitudinal assessment of outcomes.

Conclusions

Clinically important differences in quality of life and prescription topical medication use exist between patients with clear versus almost clear skin. Collectively, our results indicate that achievement of clear skin may be an important clinical distinction among patients with moderate to severe psoriasis.

Section snippets

Study design and participant protection

We conducted a cross-sectional study to compare patient-reported outcomes among patients with minimal psoriasis activity (ie, clear or almost clear skin). The study was approved by the University of Pennsylvania and University of Utah institutional review boards, and verbal informed consent was obtained from all patients. The study was conducted in accordance with the Declaration of Helsinki and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology

Results

The baseline characteristics of 97 patients with clear and 441 patients with almost clear skin on current psoriasis therapy are summarized in Table I. Patients with clear skin were older than patients with almost clear skin with mean (SD) ages of 52.6 (13.5) and 47.3 (15.5) years, respectively (P = .002). Men and women were nearly equally represented in both groups, and the majority of patients were Caucasian. There were no significant differences in median body mass index or smoking status

Discussion

In this study we compared a validated and widely used patient-reported outcome measure, the DLQI, between patients with clear and almost clear skin as defined by PGA and PASI scores determined during routine dermatologic care in academic and private practices across the United States. In univariate analyses, we found DLQI scores to be lower among patients with clear versus almost clear skin. Importantly, nearly 20% of patients with almost clear skin compared with only 2% of patients with clear

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    • Cited by (0)

    This study was supported by grant RC1-AR058204 and K24-AR064310 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Dr Gelfand), Dermatology Foundation Career Development Award (Dr Takeshita), National Psoriasis Foundation Fellowship Award (Dr Takeshita), Training Grants T32-GM 075766-6 (Dr Takeshita) and T32-AR07465 (Dr Shin) from the National Institutes of Health, and an unrestricted grant from Eli Lilly. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation or approval of the manuscript; or in the decision to submit the manuscript for publication. Eli Lilly participated in reviewing the manuscript only. All other sponsors had no role in review of the manuscript.

    Disclosure: Dr Callis Duffin was an investigator, consultant, and/or speaker for Abbvie, Amgen Inc, ApoPharma, Bristol-Myers Squibb, Celgene, Eli Lilly and Co, Genzyme, Incyte, Janssen Biologics (formerly Centocor), NovoNordisk, Pfizer, and Wyeth, receiving honoraria and/or salary; served on the advisory board of Amgen; and received residency/fellowship program funding from Abbvie Laboratories and Amgen Inc. Dr Gelfand served as a consultant for Abbvie, Amgen Inc, Celgene Corp, Eli Lilly and Co, Merck, Janssen Biologics (formerly Centocor), Novartis Corp, and Pfizer Inc, receiving honoraria; had grants or has pending grants from Abbvie, Amgen Inc, Eli Lilly and Co, Genentech Inc, Novartis Corp, and Pfizer Inc; and received payment for continuing medical education work related to psoriasis. Dr Krueger served as a consultant for Abbvie, Amgen Inc, and Janssen Biologics; had grants or has pending grants from Abbvie and Amgen Inc; and received payment for lectures and travel-related expenses from Abbvie, Amgen Inc, and Janssen Biologics. Dr Robertson is employed by the National Psoriasis Foundation, which receives unrestricted financial support from companies that make products used to treat psoriasis and psoriatic arthritis, including Abbvie, Amgen Inc, Celgene, Eli Lilly and Co, Galderma Laboratories LP, Janssen Biotech Inc, Leo Pharma Inc, Novartis, Pfizer Inc, and Stiefel, a GSK Company. Dr Robertson has also served as an uncompensated member of advisory boards at Abbvie and Merck. Dr Takeshita has received payment for continuing medical education work related to psoriasis. Dr Van Voorhees served on advisory boards for Amgen Inc, Abbvie, Genentech Inc, Warner Chilcott, Leo, and Janssen Biologics; served as an investigator for Amgen Inc and Abbvie, receiving grants; and served as a consultant for Amgen Inc. Mr Shin and Dr Troxel have no conflicts of interest to declare.

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