title: Differences in psoriasis signs and symptom severity between patients with clear and almost clear skin in clinical practice.
abstract: BACKGROUND
  In psoriasis clinical trials, treatment success is often defined as achieving a static Physician Global Assessment (sPGA) score of 0 (clear) or 1 (almost clear). Patients with clear versus almost clear skin may experience psoriasis differently. This study assessed whether aggregating these patients underestimates subjective improvements associated with total skin clearance.
  
  
  METHODS
  Patients with plaque psoriasis with stable sPGA 0 or 1 currently treated with adalimumab, etanercept, infliximab, or ustekinumab reported Psoriasis Symptom Inventory (PSI) scores for seven days and Dermatology Life Quality Index (DLQI) scores on day 8. The PSI measures psoriasis signs and symptom severity; the DLQI measures the impact of skin disease on quality of life. This analysis compared PSI and DLQI outcomes between patients with sPGA 0 and 1.
  
  
  RESULTS
  This study assessed 230 patients: 79 sPGA 0 and 151 sPGA 1. A greater percentage with sPGA 0 than sPGA 1 achieved a total PSI score of 0 ("best"; 61% vs. 5%, p < 0.0001) and DLQI 0 ("no effect"; 79% vs. 24%, p < 0.001). Patients with sPGA 0 reported better scores than sPGA 1 on all other PSI and DLQI assessments.
  
  
  CONCLUSIONS
  Achieving total skin clearance, compared with almost clear skin, provides clinically meaningful improvements in psoriasis.
authors.affiliation: a Wake Forest University School of Medicine , Winston-Salem, NC , USA .
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.affiliation: b Health Research Associates, Inc. , Mountlake Terrace , WA , USA .
authors.forename: Donald M
authors.initials: DM
authors.lastname: Bushnell
authors.affiliation: c Amgen Inc. , Thousand Oaks , CA , USA .
authors.forename: Paul A
authors.initials: PA
authors.lastname: Klekotka
authors.affiliation: b Health Research Associates, Inc. , Mountlake Terrace , WA , USA .
authors.forename: Michael
authors.initials: M
authors.lastname: Scanlon
authors.affiliation: b Health Research Associates, Inc. , Mountlake Terrace , WA , USA .
authors.forename: Mona L
authors.initials: ML
authors.lastname: Martin
authors.affiliation: d Wade Outcomes Research and Consulting , Salt Lake City , UT , USA .
authors.forename: Sally W
authors.initials: SW
authors.lastname: Wade
authors.affiliation: c Amgen Inc. , Thousand Oaks , CA , USA .
authors.forename: Wenjing
authors.initials: W
authors.lastname: Yang
authors.affiliation: c Amgen Inc. , Thousand Oaks , CA , USA .
authors.forename: Lionel
authors.initials: L
authors.lastname: Pinto
authors.affiliation: e Icahn School of Medicine , Mount Sinai , NY , USA .|f Indiana University School of Medicine , Indianapolis , IN , USA , and.|g Physicians Skin Care, PLLC and DermResearch , PLLC , Louisville , KY , USA.
authors.forename: Leon
authors.initials: L
authors.lastname: Kircik
authors.affiliation: c Amgen Inc. , Thousand Oaks , CA , USA .
authors.forename: Hema N
authors.initials: HN
authors.lastname: Viswanathan
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011565:Psoriasis / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012867:Skin / Q000473:pathology*; D063189:Symptom Assessment; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Clinical meaningfulness; Psoriasis Symptom Inventory; moderate to severe plaque psoriasis; patient-reported outcomes; static Physician Global Assessment