Definitions of remission in psoriasis: a systematic literature review from the National Psoriasis Foundation

Abstract

Psoriasis studies increasingly employ outcomes that indicate complete disease resolution, yet remission and cure are poorly defined for psoriasis. We conducted a systematic literature review to identify definitions of psoriasis remission and cure reported in the literature. Medline, EMBASE, and The Cochrane Central Register of Controlled Trials databases were searched on July 22, 2020, for full-text studies providing definitions for psoriasis remission/cure. Definitions were analysed descriptively for endpoint, time-frame, on/off treatment, patient-reported outcomes, and disease domains. We identified 106 studies that provided 41 unique remission definitions. Most definitions included endpoints based on Psoriasis Area and Severity Index (PASI), such as PASI75 (n = 16 studies), PASI90 (n = 10), PASI100 (n = 10), and PASI of 0 (n = 3), and descriptive endpoints related to 'skin clearance' (n = 18). Few definitions specified time-frame, on/off treatment or other psoriasis-related disease domains. One small consensus-initiative defined drug-free remission for plaque psoriasis by BSA of 0 without any therapy for at least 12 months. While there is no cure for psoriasis, seven studies defined psoriasis cure using similar endpoints to those used to define remission. We identified a variety of definitions of psoriasis remission. These results will inform the development of consensus-based definitions for psoriasis remission to support efforts to improve research and clinical outcomes.

A Case of Concurrent Psoriasis and Hidradenitis Suppurativa Successfully Treated with Tildrakizumab

“…Despite the long-term control with guselkumab for 3 years, the treatment was switched to tildrakizumab 200 mg, owing to a relapse of hidradenitis suppurativa. To the best of our knowledge, this is the first reported case on successful use of tildrakizumab to treat concomitant psoriasis and hidradenitis suppurativa, with the patient achieving HiSCR [ 10 , 11 ] and PASI 100 [ 15 ] responses after only four tildrakizumab doses. These results suggest that clinical effect of IL-23p19 inhibitors might be influenced by genetic background or gene interactions, showing a different effect depending on the anti-IL-23p19 agent [ 14 , 16 ], although the use of a higher dose (200 mg) could also play a role.…”

Clinical characteristics and outcomes of psoriasis patients with COVID-19: A retrospective, multicenter cohort study in China

“…As a result, these highly suspected cases were included in our cohort analysis for SARS-CoV-2 infections. Exacerbation of psoriasis was defined based on the following criteria [ 16 ] : increased involvement of body surface area and patient-reported worsening. Those without these manifestations were classified as remission/no change.…”