CLINICAL REPORT
335 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Correlation Between Dermatology Life Quality Index and Psoriasis Area and Severity Index in Patients with Psoriasis Treated with Ustekinumab
Jeanette Halskou HESSELVIG , Alexander EGEBERG , Nikolai Dyrberg LOFT , Claus ZACHARIAE , Kristian KOFOED and Lone SKOV Department of Dermatology and Allergy , Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
Monitoring of biological treatment efficacy for psoriasis is based on clinical evaluation and patient ’ s quality of life . However , long-term correlation between Psoriasis Area and Severity Index ( PASI ) and Dermatology Life Quality Index ( DLQI ) in real life has not been studied in patients treated with ustekinumab . All patients with psoriasis treated with ustekinumab at our department were included ( n = 120 ) in this study . Correlation analyses between the change in PASI and DLQI and the individual subquestions in DLQI were performed using Spearman ’ s rank correlation coefficient . A correlation value of 0.57 ( p-value < 0.001 ) and 0.45 ( p-value < 0.001 ) between PASI and DLQI were found in the period baseline – 4 months and baseline – 12 months , respectively . In DLQI subquestions , the greatest association was found for the questions on “ Symptoms and feelings ”. Objective improvements in the severity of psoriasis were weakly to moderately associated with improvements in quality of life in patients with psoriasis treated with ustekinumab .
Key words : psoriasis ; PASI ; DLQI ; correlation ; ustekinumab . Accepted Oct 31 , 2017 ; Epub ahead of print Nov 7 , 2017 Acta Derm Venereol 2018 ; 98 : 335 – 339 .
Corr : Jeanette Halskou Hesselvig , Department of Dermatology and Allergy , Herlev and Gentofte Hospital , University of Copenhagen , Kildegårdsvej 28 , DK-2900 Hellerup , Denmark . E-mail : jeanette . halskou . hesselvig @ regionh . dk
Initiation and evaluation of the effect of biologic treatment for psoriasis is based on clinical evaluation by the treating physician and on the patient ’ s quality of life ( QoL ). The Dermatology Life Quality Index ( DLQI ) is used to measure patient ’ s self-reported QoL . The severity of psoriasis lesions is often assessed with the Psoriasis Area and Severity Index ( PASI ) ( 1 – 3 ). During the first 10 – 16 weeks of biologic treatment , a strong correlation is seen between reduction in PASI and reduction in DLQI ( 4 ). In addition to improvements in the symptoms and severity of psoriasis , clinical trials with ustekinumab have shown an improvement in QoL ( 5 , 6 ). However , to our knowledge , long-term correlation between PASI and DLQI has not been investigated in patients treated with ustekinumab . Moreover , it is unclear whether and how the individual subquestions in the DLQI questionnaire are correlated with PASI in patients with psoriasis .
The aim of the current study was therefore to examine the potential correlation between changes in DLQI and
PASI in patients with psoriasis treated with ustekinumab by conducting a register-based cohort study in a single hospital clinic in Denmark .
METHODS Data sources and study population
The study was approved by the Danish Data Protection Agency ( ref . HGH-2016-048 , I-Suite : 04520 ). In Denmark , ethical approval is not required for registry studies . The study was conducted in accordance with the Strengthening the Reporting of Observational Studies ( STROBE ) recommendations ( 7 ).
According to Danish guidelines , biologic therapy can be given to patients with moderate-to-severe psoriasis ( defined as PASI > 10 , DLQI > 10 , or affected body surface area ( BSA ) > 10 %), in whom previous conventional systemic treatments have failed , or for whom conventional systemic treatments are contraindicated ( 1 ).
The present study was a cohort study with data collected prospectively . All patients with plaque psoriasis treated with ustekinumab from the Department of Dermatology , Gentofte Hospital , Denmark , were included .
All of the patients who are treated with ustekinumab should have PASI and DLQI registered , at least at baseline , usually after 4 months , and then every year . Patients with missing baseline data either for DLQI or PASI were excluded . Ustekinumab has been available in Denmark since April 2009 ( 8 ). The last data entry in the present study was March 2017 . Since 2012 , the national guidelines have recommended ustekinumab as first-line biologic treatment for patients with moderate-to-severe psoriasis with no joint involvement , i . e . psoriatic arthritis or psoriatic arthropathy . Information on PASI and DLQI was obtained from the baseline ( the date of first treatment with ustekinumab ) and from the 4- and 12-month visits , respectively . Data were observational , from a real-life setting , and there was therefore no requirement for a wash-out period between the previous treatment and the start of treatment with ustekinumab .
Dermatology Life Quality Index
The DLQI is an assessment tool with 10 questions , which is used to measure the effect of skin disease on the QoL of the patient ( 9 ). The DLQI total score ranges from 0 to 30 , with 0 corresponding to no impairment of the QoL and 30 to maximum impairment due to the skin disease . The questions are divided into the following topics : “ Symptoms and feelings ” ( questions 1 and 2 ), “ Daily activities ” ( questions 3 and 4 ), “ Leisure ” ( questions 5 and 6 ), “ Work or school ” ( question 7.1 and 7.2 ), “ Personal relationships ” ( questions 8 and 9 ), and “ Treatment ” ( question 10 ) ( 9 ).
Psoriasis Area and Severity Index
PASI is an index that is used to measure the severity of psoriasis lesions . It combines the severity of 3 clinical signs ( erythema , induration ( plaque thickness ), and desquamation ), the percentage
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2018 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2833 Acta Derm Venereol 2018 ; 98 : 335 – 339