Quality of Life Assessment in Psoriasis

In choosing which type of treatment should be applied, it is important to try and define who should be treated with what medication, and specifically with the new specific drugs that are available. Severity on pure surface area is not an adequate enough determination and clearly the impairment of quality of life has to be incorporated into the decision. An interesting and helpful position paper from the Medical Advisory Board of the National Psoriasis Foundation suggested three different categories.

Psoriasis can have a significant impact on a patient’s quality of life - sometimes profoundly altering their everyday life.

There are a number of surveys that have been designed. Some are very specific for psoriasis itself while others are dermatology specific. Yet others will compare diseases not affecting the skin as a comparison of disease impact. At least four specific psoriasis questionnaires have been developed. The psoriasis life stress inventory is a fifteen item tick box questionnaire involving the impact of psoriasis on the previous month’s quality of life. The psoriasis quality of life questionnaire developed on a population based survey where there are twenty-two items specifically on the impact of psoriasis and nineteen regarding day to day living.

The Psoriasis Disability Index

This is a questionnaire addressing fifteen aspects including daily activities, personal relationships, vacation, work as well as the effects of actual treatment. This has been used in a number of clinical studies.

The Dermatology Life Quality index was used as a measure of improvement in studies with alefacept (Amevive). This is a questionnaire relating to the previous week’s activities and feelings. Work, school, leisure, daily activities as well as the symptoms and feelings are measured as well as personal relationships and the impact of treatment.

A Quality of Life patient survey published in the Archives of Dermatology in 2001 showed interesting results. The survey of the US National Psoriasis Foundation of 40,350 patients when over 17,000 responded. The information from this suggests that physicians underestimate the disease severity.

PASI - The Psoriasis Area and Severity Index

The National Psoriasis Foundation physician forum in the summer of 2002 suggested a scale by which patients could indicate improvement or worsening of their condition and specific treatments. At the baseline visit a patient was asked to rate their psoriasis on a scale of 1 to 10 with 10 being the worst episode of psoriasis ever and 1 as being completely clear. This is a practical way of dynamically assessing the patient’s perception and can be used in combination with the physician assessment of PASI. This is the Psoriasis Area and Severity index.

This measures surface area which is broken into the head, upper extremities, trunk and lower extremities. The lesions are given a score for redness, thickness and scaling. A formula is then applied to give a score which can be used for following improvement or worsening during a clinical trial.

PGA - The Physician Global Assessment Scale

Another means of assessing is the physician global assessment scale (PGA). This is the physician’s assessment of the psoriatic plaques. This is a seven point scale with 7 being clear and 6 almost clear, 5 mild, 4 mild to moderate, 3 moderate, 2 moderately severe and 1 being severe psoriasis. More work needs to be done on refining the tools for measuring the impact of psoriasis on an individual. This is very important as it can be used as a tool of measuring the impact of treatment on the patient.

The Goals Of Psoriasis Treatment Include:

Dovobet®

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INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ...

PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ...

DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ...

EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ...

COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ...

COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...

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