Aiming for PASI 100
Psoriasis severity scales
Psoriasis severity is determined using several scales; the main ones being:
- Body Surface Area (BSA) – the percentage of BSA affected by psoriatic lesions where the patient’s palm is estimated to be 1% BSA. Moderate-to-severe psoriasis is classed as having a BSA score ≥10 (10%) (National Psoriasis Foundation, 2018)
- Psoriasis Area Severity Index (PASI) – the percentage reduction in disease severity (compared with baseline) observed following treatment. Commonly used PASI scores include PASI 50, 75, 90 and 100 indicating reductions of 50%, 75%, 90% and 100%, respectively (Feldman & Krueger, 2005)
The evolution of biologics for treating psoriasis
Biologics such as anti-tumour necrosis factor (TNF) and the anti-IL-12/23 treatment ustekinumab, show lower efficacy in clinical trials of moderate-to-severe psoriasis when compared (head-to-head or network meta-analysis) with more recently developed biologics, such as anti-IL-17 therapies and IL-23’s (Blauvelt et al., 2017b; Reich et al., 2017; Sawyer et al., 2018a).
Between 27‒80% of patients on ‘older’ biologics reach PASI 75 by 12–16 weeks (Hartz et al., 2016; Zweegers et al., 2016) and in general less patients achieve higher PASI scores and sustained efficacy during maintenance treatment than with more recently developed biologics (Sawyer et al., 2018a).
Why PASI 100 is so important
Achieving PASI 100 substantially reduces the physical burden of psoriasis and improves patient satisfaction, compared with having any residual disease (Lebwohl et al., 2015; Puig et al., 2017).
Key clinical data
Modern biological therapies that specifically block the IL-17 pathway and achieve complete skin clearance, a Psoriasis Area Severity Index 100 score (PASI 100), with an acceptable safety profile, represent a paradigm shift in the treatment of moderate-to-severe psoriasis (Strober et al., 2016; Wasilewska et al., 2016).
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