Background and Importance Psoriasis is a chronic inflammatory skin disease in which moderate to severe forms can be treated with monoclonal antibodies (mAbs). Assessment of disease improvement is usually made by the Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA). However, sometimes patients‘ feelings do not correlate with these scores.
Aim and Objectives To describe the symptoms and signs in patients with moderate-to-severe psoriasis by using Psoriasis Symptoms and Signs Diary (PSSD).
Material and Methods Prospective observational study conducted between 1-February-2022 and 30-September-2022 in a university hospital. Patients treated at least 3 months with mAbs were included. Data collected: age, sex, diagnostic, mAbs prescribed, previous treatments, PASI and BSA scores. PSSD was used to measure patient-reported outcome (PRO). It assesses the severity of psoriasis symptoms (itching, tightness, burning, pain) and signs (bleeding, cracking, dryness, scaling, shedding, redness) using a 0–10 numerical rating scale. Summary scores were derived using a scale of 0–100. Patients with a PSSD score ≥20 were referred to the dermatology service to assess the mAb switching. Data were obtained from electronic medical records and patients’ interviews.
Results Thirty-eight patients completed the PSSD (50% women) with a median age 51.3 (37.8–61.4) years, 84.2% with psoriasis and 15.8% also with psoriatic arthritis (PA) as comorbidity. mAbs prescribed: adalimumab (44.7%), ustekinumab (13.1%), guselkumab (10.5%), tildrakizumab (10.5%), risankizumab (7.9%), secukinumab (5.3%), brodalumab (5.3%), ixekizumab (2.7%). Twenty-four patients (63.2%) received mAbs as the first line, 21.0% as the second-line and 13.1% as the third or more lines. Eight patients had PASI >2. The PSSD average score was: itching 1.9 ± 2.9, dryness 3.5 ± 2.8, cracking 1.2 ± 2.4, tightness 1.4 ± 2.2, scaling 1.2 ± 2.2, shedding 2 ± 2.9, redness 2.3 ± 2.7, bleeding 0.5 ± 1.5, burning 1.2 ± .2.2, pain 0.5 ± 1.6. Dryness was the highest rated and bleeding the lowest score. Twelve patients (31.6%) had a PSSD score of ≥20 and the main treatment was adalimumab (41.6%). Three patients switched the mAb. Only in five patients the PASI and BSA scores were correlated with PSSD.
Conclusion and Relevance PSSD is a reliable and valid PRO instrument for assessing psoriasis-associated symptoms and signs in patients treated with mAbs in clinical practice. This score, together with PASI and BSA, could be used to guide mAbs switching.
Conflict of Interest No conflict of interest.
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