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Metrics to Determine Disease Clearance in Plaque Psoriasis


Laura Bush, DMSc, PA-C, and Terry Faleye, MPAS, PA-C, discuss metrics to determine clearance in plaque psoriasis and how the provider’s expectations may be different from the patient’s expectations.

Alexa Hetzel, MS, PA-C: Laura, when somebody comes into the office and you’re evaluating how effective a treatment therapy or regimen is that you’ve set up for somebody, what metric do you use?

Laura Bush, DMSc, PA-C: I use BSA [body surface area], maybe IgA, and if they’re happy. The big thing with patients is you can look at them and think they’re here for 1 thing, but they’re here for something completely different. I always ask, are you happy with it? I may not be happy with it, but they might be. I listen to my patient on their happiness with the degree of success they’ve had. I also encourage them to give time too because a lot of times they want it yesterday. That’s where we can add topicals and bridge that gap. But mainly [I look at] whether the patient is happy and the BSA.

Lakshi, when you were speaking, I was thinking about a patient I had with 1% BSA, but the 1% was in his genitals, and he was a young man. I said, “Your 1% is 100%.” He said, “Finally, someone gets me.” His 1% needed to be treated aggressively. Listen to your patient, see if they’re happy, encourage them to be patient because it takes some time. There’s a reason studies are done at 16 and 24 weeks. Even with other conditions, I say, “These studies are done like this because that’s how long it takes.” I mainly listen to my patient, look at BSA and IgA, and document that.

Alexa Hetzel, MS, PA-C: Perfect. Terry what’s the importance of long-term efficacy and safety?

Terry Faleye, MPAS, PA-C: The importance is high, especially when patients are first coming to us. The first thing that they think about is, does this work? Not only that, but is it safe? At the same time, they ask, can I get it? That’s always the third 1. Those 2 things off the bat are important, because long-term safety is if I get this patient on therapy and they remain clear for a lengthy period of time. That way, I’m not having to transition to another agent.

At the same, if a patient is happy with what they’re receiving and their clearance level, then I look at it more clinically. Is that a case where I can look at data all day, and I can look at these end points and what this looks like at week 16. When most of these patients come into us, they have no clue what week 16 is. They don’t know what PASI [Psoriasis Area and Severity Index] is.... The reality is that they want to get clear. I rely want to get you clear and keep you safe. If I’m able to achieve those, then it’s a win. At the end of the day, I always tell my patients that it’s truly a marathon. It’s definitely not a sprint. We’re educating them and letting them know that it’s a journey and we’re going to get there. If you’re patient enough in the journey, you’ll get the results that you’re looking for.

Alexa Hetzel, MS, PA-C: If our patients are happy, if we’re happy, and we can all sleep at night, that’s a win for sure. Especially now, patients might not even understand what clearance means or what better means. You want to quantify that. We have a metric measure, but I have patients who come in and just want to wear shorts in the summer. That’s what’s important to them. I might have different goals for them, but that’s what their goal is. They might perceive their treatment as good because you can see the legs, but they still have genital psoriasis or their joints aren’t good. There are still a lot of things that always come into play, and the conversation is always different and evolving every time they come into the room. It’s funny what everybody’s goals are.

Transcript edited for clarity

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