Quality-of-Life Instruments: Evaluation of the Impact of Psoriasis on Patients
Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco Medical Center, 515 Spruce Street, San Francisco, CA 94118, USA. Dermatologic clinics
(Impact Factor: 1.69).
04/2012; 30(2):281-91, ix. DOI: 10.1016/j.det.2011.11.006
The negative impact of psoriasis on a patient's quality of life (QoL) is well documented in the literature. Patients often suffer poor self-esteem, difficulties in social interactions, and significant psychological distress. It is, therefore, critically important that a clinician evaluate the extent to which the disease impacts a patient's QoL. This chapter reviews several validated and reliable generic, dermatology-specific, and disease-specific QoL instruments useful in measuring the impact of psoriasis on patient's QoL. These QoL instruments can be especially helpful in identifying those patients who would most benefit from systemic or biologic therapy.
Available from: Seyed Shamsian
- "Environmental and genetic factors, as well as super antigens and toxins from Candida species, may play various roles in the exacerbation and persistence of psoriasis (Taheri et al., 2014; Leung et al., 1993). Most psoriasis patients have a diminished quality of life in comparison with healthy individuals, particularly with reference to sexual dysfunction, anxiety, depression, selfesteem , and nutritional condition (Heller et al., 2012). In the present study, the presence of Candida albicans and other species of Candida were evaluated in the saliva and skin of fifty (50) psoriatic patients and were compared to a control group of fifty (50) healthy people. "
Available from: Federico Spandonaro
- "In general, psoriasis is usually classified as mild, moderate or severe, depending on the surface area affected, redness, and the thickness and desquamation of the plaques. A number of instruments have been devised to define the severity of the disease and compare scores over time for the same patient and between patients . "
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ABSTRACT: Biologic therapies are considered to be cost effective by leading Health Technology Assessment (HTA) agencies and, therefore, eligible for reimbursement by public health services. However, biologic therapies entail sizable incremental costs and, besides, have a considerable financial impact that in Italy amounts to 13.7 % of the national health service's pharmaceutical expenditure. In the reimbursability decision process, an important role is played by both the drug efficacy data observed in pre-licensing RCTs and the economic modelling assumptions, as they give evidence on cost effectiveness. The administration of therapies in real practice settings is likely to produce a significant deviation from the results predicted by the models, theoretically outweighing the assumption on which the decision process is founded. This is a matter of concern for public health services and, consequently, an interesting topic to investigate.
To overcome the lack of knowledge concerning the actual cost effectiveness of biologic therapies for the treatment of plaque psoriasis in the clinical practice setting in Italy, an observational study was conducted in 12 specialist centres on patients switching to biologic therapy within a 6-month enrolment window.
The study confirms in clinical practice the efficacy of the switch to biologic therapies, analysed using a number of clinical [Psoriasis Area and Severity Index (PASI), pain visual analogue scale (VAS) and itching VAS] and quality-of-life parameters. A general health-related quality of life (HR-QOL) improvement, with a 0.23 quality-adjusted life-year (QALY) mean gain per patient, has been reported in the 6-month observation period. The direct medical costs to treat plaque psoriasis with biologic therapies amount to 15,073.7 per year (prior to their enrolment, the same patients cost 2,166.2 on an annual basis). After the switch to biologic agents, the cost per QALY during the first year of treatment amounts to 28,656.3.
At least in the short-term, the clinical practice of the specialised Italian centres taking part in the study confirms that switching patients to a biologic drug produces an incremental cost-effectiveness ratio comparable with the values predicted by the HTA bodies.
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ABSTRACT: There are limited long-term, "real-world" data on ustekinumab, or the effect of dose adjustment in suboptimal responders.
We describe 52-week data from TRANSIT, which initiated ustekinumab by licensed regimen and investigated exploratory dose adjustment.
Patients with moderate-to-severe psoriasis and inadequate methotrexate response initiated ustekinumab, with immediate or gradual methotrexate withdrawal. Outcomes were similar between treatment arms at week 12 (primary endpoint), so week 52 data are pooled. Patients weighing ≤100 kg or >100 kg initiated 45 mg or 90 mg ustekinumab, respectively. Patients weighing ≤100 kg without psoriasis area and severity index (PASI) 75 response at weeks 28 or 40 received a dose adjustment to 90 mg. The primary analysis used observed data.
Overall, 391 and 98 patients initiated ustekinumab 45 mg and 90 mg, respectively. Forty-four patients (9%) discontinued before week 52 (0.4% due to adverse events). At week 52 (in the overall population), 369 patients (83%) achieved PASI ≤5, and 341 patients (77%) achieved PASI 75; median PASI decreased to 1.8 from 15 at baseline. At weeks 28 and 40, 84 and 31 patients, respectively, did not achieve PASI 75 and received a dose adjustment; by week 52, 35/82 (43%) and 15/31 (48%) of these patients, respectively, achieved PASI 75 (two discontinued between weeks 28-40).
Ustekinumab showed sustained 1-year efficacy and was well tolerated when initially administered according to label. Adjusting ustekinumab dose to 90 mg may result in clinically meaningful improvement in response in patients ≤100 kg with suboptimal initial response. This article is protected by copyright. All rights reserved.
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