Abstract
Psoriatic disease is a chronic condition that affects both physical and psychological health. Some patients experience stigmatisation, as well as social and professional limitations. The detrimental impacts of the condition can be summarised under the overall umbrella of wellbeing, with evidence accumulating that psoriasis impacts the wellbeing of both patients and their families. Patients with psoriasis have traditionally been evaluated using the Psoriasis Area Severity Index (PASI), which assesses disease severity, and the Dermatology Life Quality Index (DLQI), which examines quality of life. Both of these measures fail to adequately evaluate wellbeing.
In these interviews with EMJ, Matthias Augustin, Director of the Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Germany; and Ulrich Mrowietz, Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany describe the landmark POSITIVE study, the relevance of looking beyond skin lesions and including measures of wellbeing in clinical practice, and how the 5-item World Health Organization Well-Being Index (WHO-5) can be used to assess wellbeing in patients with psoriasis. They discuss POSITIVE, the first clinical study in dermatology to use patient-reported wellbeing, assessed using the WHO-5, as a primary endpoint to estimate the impact of the IL-23p19 inhibitor, tildrakizumab, on overall wellbeing in a real-world setting. The POSITIVE study is a new landmark for psoriasis management, and demonstrated that treatment with tildrakizumab was associated with improvements in disease severity, and increased wellbeing of patients, recovering back to normal population levels. This is the first time that a biologic treatment for psoriasis has shown these results. The interviewees concluded that wellbeing assessments should be incorporated into daily clinical practice to evaluate treatment response, and provide patients with more holistic management.