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Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Canadian Treat-to-Target Practice Survey of Real-World Interventions and Strategies in Psoriasis (CAN TARGET
Jensen Yeung1,2,3,4, Parbeer Grewal5,6, Perla Lansang7,8,9,10
1Division of Dermatology, Women's College Hospital, Toronto, ON, Canada. jenseny@hotmail.com.
Introduction:
Treat-to-target (T2T) strategies have been proposed to support decision-making in chronic plaque psoriasis care, but their use in Canadian clinical practice has not been well studied.
Methods:
This retrospective chart review examined how Canadian T2T criteria are applied for adult patients with moderate-to-severe plaque psoriasis and whether treatment decisions reflect treatment target achievement in clinical practice. Charts from 438 adults who initiated or modified biologic therapy and completed two visits 3-8 months apart were included. Treatment target achievement at visit 2 was assessed using predefined major and minor criteria, which included Psoriasis Area and Severity Index (PASI), body surface area (BSA), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI) outcome measures.
Results:
Of the 438 patients, 321 (73.3%) met the treatment target and 98.4% of these continued their current biologic therapy. Among the 117 patients who did not meet the treatment target, 48.7% of remained on their current biologic therapy. Treatment target achievement was associated with lower PASI, BSA, PGA, and DLQI scores. DLQI influenced treatment modification even when treatment targets were unmet. Switching between interleukin (IL)-17 and IL-23 inhibitors was the most frequent treatment modification strategy.
Conclusion:
Findings support the clinical value of Canadian T2T criteria, while highlighting the importance of shared decision-making. Many patients who did not meet treatment targets remained on their current biologic therapy, emphasizing the role of patient input, quality of life, and physician judgment. These results reinforce the importance of balancing treatment targets with individualized care in real-world plaque psoriasis management.
Insights
Canadian treat-to-target (T2T) criteria are valuable for managing chronic plaque psoriasis. However, patient input and quality of life significantly influence treatment decisions, even when targets aren't met.
Area of Science:
- Dermatology
- Clinical Practice Research
Background:
- Treat-to-target (T2T) strategies are proposed for chronic plaque psoriasis care.
- Their application in Canadian clinical practice requires further study.
Purpose of the Study:
- To examine the application of Canadian T2T criteria in adult patients with moderate-to-severe plaque psoriasis.
- To assess if treatment decisions align with treatment target achievement in real-world clinical settings.
Main Methods:
- Retrospective chart review of 438 adult patients with moderate-to-severe plaque psoriasis initiating or modifying biologic therapy.
- Assessment of treatment target achievement at two visits (3-8 months apart) using Psoriasis Area and Severity Index (PASI), body surface area (BSA), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI).
Main Results:
- 73.3% of patients met treatment targets, with 98.4% continuing their current biologic.
- Among those not meeting targets (48.7%), many remained on current therapy, influenced by DLQI scores.
- Treatment target achievement correlated with lower PASI, BSA, PGA, and DLQI scores.
Conclusions:
- Canadian T2T criteria demonstrate clinical value in plaque psoriasis management.
- Shared decision-making, patient quality of life (DLQI), and physician judgment are crucial alongside T2T.
- Individualized care balancing treatment targets with patient factors is essential for effective plaque psoriasis management.
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