Plaque Psoriasis


Real-World Data on Patient-Reported Outcomes in Psoriasis Treatment

patient care perspectives by Steven R. Feldman, MD, PhD

The effects of plaque psoriasis on patients’ physical and psychological well-being are considerable, and the rapid improvement of symptoms is often a key treatment objective for patients. The incorporation of patient perspectives into treatment decision making can improve patient satisfaction, health-related quality of life, and clinical outcomes.

Expert Commentary
“Patient-reported outcomes and objective clinical outcomes go hand in hand when treating patients with plaque psoriasis. . . . It is not always the case that improving a disease objectively would also lead to positive subjective outcomes, but, in the treatment of psoriasis, these are very closely related.”
— Steven R. Feldman, MD, PhD

Patient-reported outcomes and objective clinical outcomes go hand in hand when treating patients with plaque psoriasis. Those with worse lesions objectively typically report greater subjective impact overall. The more that plaque psoriasis lesions improve though effective treatment, the more you can improve a patient’s perceived outcomes and quality of life. It is not always the case that improving a disease objectively would also lead to positive subjective outcomes, but, in the treatment of psoriasis, these are very closely related.


Plaque psoriasis has a significant impact on patients’ lives. Early in my career, my colleagues and I conducted a detailed, intensive survey of patients with psoriasis. We learned that their disease affected many aspects of their daily lives: physical, social, work, sleep, play, and even how they dressed. Ultimately, these factors create the combined effect of a disease that greatly impacts patient well-being. We can measure psoriasis lesions and track how they change with treatment, but what we really want to do is eliminate the overall negative effect that psoriasis has on our patients’ lives. Fortunately, the treatments that are now available can completely or nearly completely clear patients’ lesions. Those treatments also dramatically decrease the symptoms of plaque psoriasis and restore patients’ quality of life.


In general, when discussing patients’ treatment goals, I find that my patients want a fast-acting, safe, effective cure for their plaque psoriasis. We now have treatments that bring us very close to fulfilling those preferences. When discussing treatment options with patients, I find that some may prefer the fastest-acting option and might be willing to take on some risk of adverse events. Others are more focused on safety and are willing to wait a little longer for lesion improvement. We can advise patients on the relative speed of onset of the drugs by looking at clinical trial data and seeing how long it takes to achieve a 50% improvement in the disease. Our fastest-acting drugs may achieve this in just 1 or 2 weeks; other effective treatments may take 10 to 14 days longer. Does that make a difference? We might not think so as practitioners who write a prescription and then see the patient for follow-up in a few months because either option will likely clear their lesions by then. However, a patient who is suffering certainly might want to see improvements 2 weeks quicker and might be willing to take on some safety risks to achieve that goal.


I remember when etanercept became available as perhaps the first highly effective biologic agent for psoriasis. Etanercept revolutionized the treatment of plaque psoriasis. I prescribed it to a patient I had at the time—the father of a few young children—who later came in and said to me, “This therapy has been life changing. I didn’t realize the full effect the disease was having on me. As soon as I started the therapy, my energy was so much better, and I could play soccer with my kids.” It is important to realize that therapy for plaque psoriasis has continued to evolve, and the drugs that we have available now are even more effective and safe. This has allowed us to continue to improve patient outcomes, both clinically and from a quality-of-life standpoint.


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Strober B, Greenberg JD, Karki C, et al. Impact of psoriasis severity on patient-reported clinical symptoms, health-related quality of life and work productivity among US patients: real-world data from the Corrona Psoriasis Registry. BMJ Open. 2019;9(4):e027535. doi:10.1136/bmjopen-2018-027535

Steven R. Feldman, MD, PhD

Professor of Dermatology, Pathology, and Social Sciences & Health Policy
Wake Forest University School of Medicine
Winston-Salem, NC