Pediatric patients with psoriasis who experience a significant improvement in disease severity after treatment may experience the greatest positive impact to quality of life (QOL), finds a recent study from JAMA Dermatology.1
Investigators of the study, published in November 2019, also found that the type of treatment prescribed may play a role in QOL rating independent of disease severity.
It is well-known that psoriasis can negatively impact both adults and pediatric patients with the disease; however, the connection between degree of disease severity and improvement in QOL has not been as extensively studied in children with psoriasis as it has in adults with the condition.
“To our knowledge, this cohort study is the first to examine in a real-world setting the association between the degree of psoriasis improvement and quality of life in pediatric patients with psoriasis,” write the study authors.
The single-center cohort study analyzed data from 319 pediatric patients 18 years of age or younger stored in Child-CAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry). The individuals assessed received treatment in the outpatient clinic of the department of dermatology at the Radboud University Medical Center, Nijmegen, Netherlands, between Sept. 3, 2018 and March 4, 2018. Researchers used records of validated Children’s Dermatology Life Quality Index (CDLQI) scores, Psoriasis Area and Severity Index (PASI) scores and body surface area (BSA) scores in their analysis.
Treatment types were categorized as topical, dithranol, conventional systemic and biological therapy. The researchers note that cases which involved UV-B phototherapy were excluded due to low numbers.
The study investigators measured degree of disease severity and improvement in QOL by analyzing the mean change of CDLQI score per PASI and BSA response, which were divided into four groups: 0 to <50, 50 to <75, 75 to <90, and ≥90. They used the mean CDLQI change in each treatment category to examine which treatment type was associated with the most impact to QOL.
According to the study, patients who achieved PASI ≥90 or BSA ≥90 experienced the greatest improvement to QOL with the estimated marginal mean changes in CDLQI scores of -6.6 (95% CI, -7.5 to -5.7) and -6.8 (95% CI, -7.5 to -6.1), respectively.
These results appear to be in line with previous studies that have examined the relationship between PASI score and improvement to QOL in both adults and pediatric patients2 with psoriasis, according to the study.
The researchers note, however, that the relationship between BSA involvement and QOL appears to be a unique finding.
“To our knowledge, the association between BSA decrease and QOL improvement has never been investigated in children and adults,” they write. Though more research is needed, the authors go on to suggests that, due to these results, dermatologists may want to consider using BSA as a tool to assess psoriasis in practice.
Dermatologists should also keep in mind that pediatric patients with psoriasis may see the greatest benefit to QOL when treated with conventional systemic or biological therapies. In this analysis, researchers found the most improved change in CDLQI score in participants receiving systemic treatments (conventional systemic and biological therapies, EMM change in CDLQI -5.8 [95% CI, -6.7 to -4.9] and -5.8 [95% CI, -7.5 to -4.1], respectively) vs. those receiving topical therapies (topical and dithranol, EMM change in CDLQI -4.3 [95% CI, -4.8 to -3.8] and -4.2 [95% CI, -4.9 to -3.5], respectively).
Researchers also adjusted their analysis to prove that the change in CDLQI score between treatment type was independent of PASI score improvement, as systemic therapies are known to achieve higher PASI responses. They also adjusted for age, sex, disease duration and treatment duration.
“The weaker association between topical treatment and improvement in QOL might be attributed to several characteristics of topical agents, such as time taken to apply ointments, odors, and stickiness,” the authors propose, although they did not perform any investigation into specific advantages or disadvantages to any treatment type in regard to QOL impact.
Ultimately, this study suggests that reaching PASI 90 or greater and reducing BSA involvement may be worthwhile treatment goals for dermatologists and their pediatric patients – and systemic treatments, both conventional and biological, may offer the most realistic means to achieving optimal QOL.