Keck School of Medicine, University of Southern California, Los Angeles, California.
National Psoriasis Foundation, Portland, Oregon.
J Am Acad Dermatol. 2017 Feb;76(2):290-298. doi: 10.1016/j.jaad.2016.10.017. Epub 2016 Nov 28.
BACKGROUND: An urgent need exists in the United States to establish treatment goals in psoriasis. OBJECTIVE: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice. METHODS: The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre-Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds. RESULTS: A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or more from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less. LIMITATIONS: Although BSA is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side effects. CONCLUSION: With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.
背景:美国迫切需要在银屑病中建立治疗目标。
目的:我们旨在确定明确的治疗目标,使银屑病患者和临床医生能够努力实现这些目标,以做出治疗决策,减轻疾病负担,并改善实际治疗效果。
方法:国家银屑病基金会利用德尔菲法在银屑病专家中进行了一项共识研究。该过程包括:(1)文献回顾;(2)预德尔菲问卷选择以及普通皮肤科医生和患者的意见输入;(3)进行四轮德尔菲调查。
结果:共有 25 名银屑病专家参与了德尔菲调查过程。最受欢迎的工具是体表面积(BSA)。评估新疗法开始后患者反应的最佳时间是 3 个月。可接受的反应是开始治疗后 3 个月时 BSA 减少 3%或更少,或 BSA 改善 75%或更多;目标反应是开始治疗后 3 个月时 BSA 减少 1%或更少。在维持期,每 6 个月评估一次是最受欢迎的。每次 6 个月维持评估的目标反应是 BSA 减少 1%或更少。
局限性:尽管 BSA 在实践中是可行的,但它不包括健康相关的生活质量、成本和副作用风险。
结论:通过确定治疗目标,临床医生和患者可以定期评估治疗反应,并对针对患者的治疗方案进行获益-风险评估。
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