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