Περίληψη:
Patients with moderate to severe psoriasis are undertreated. To solve
this persistent problem, the consensus programme was performed to define
goals for treatment of plaque psoriasis with systemic therapy and to
improve patient care. An expert consensus meeting and a collaborative
Delphi procedure were carried out. Nineteen dermatologists from
different European countries met for a face-to-face discussion and
defined items through a four-round Delphi process. Severity of plaque
psoriasis was graded into mild and moderate to severe disease. Mild
disease was defined as body surface area (BSA) <= 10 and psoriasis area
and severity index (PASI) <= 10 and dermatology life quality index
(DLQI) <= 10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10)
and DLQI > 10. Special clinical situations may change mild psoriasis to
moderate to severe including involvement of visible areas or severe nail
involvement. For systemic therapy of plaque psoriasis two treatment
phases were defined: (1) induction phase as the treatment period until
week 16; however, depending on the type of drug and dose regimen used,
this phase may be extended until week 24 and (2) maintenance phase for
all drugs was defined as the treatment period after the induction phase.
For the definition of treatment goals in plaque psoriasis, the change of
PASI from baseline until the time of evaluation (Delta PASI) and the
absolute DLQI were used. After induction and during maintenance therapy,
treatment can be continued if reduction in PASI is >= 75%. The
treatment regimen should be modified if improvement of PASI is <50%. In
a situation where the therapeutic response improved >= 50% but <75%,
as assessed by PASI, therapy should be modified if the DLQI is >5 but
can be continued if the DLQI is <= 5. This programme defines the
severity of plaque psoriasis for the first time using a formal consensus
of 19 European experts. In addition, treatment goals for moderate to
severe disease were established. Implementation of treatment goals in
the daily management of psoriasis will improve patient care and mitigate
the problem of undertreatment. It is planned to evaluate the
implementation of these treatment goals in a subsequent programme
involving patients and physicians.
Συγγραφείς:
Mrowietz, U.
Kragballe, K.
Reich, K.
Spuls, P. and
Griffiths, C. E. M.
Nast, A.
Franke, J.
Antoniou, C. and
Arenberger, P.
Balieva, F.
Bylaite, M.
Correia, O. and
Dauden, E.
Gisondi, P.
Iversen, L.
Kemeny, L.
Lahfa, M.
and Nijsten, T.
Rantanen, T.
Reich, A.
Rosenbach, T. and
Segaert, S.
Smith, C.
Talme, T.
Volc-Platzer, B. and
Yawalkar, N.
