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SAN DIEGO -- The scientific program of the American Academy of Dermatology annual meeting included dozens of poster presentations, spread over four days. Several of the posters are summarized below.

Correlation Between BSA, QOL

Quality of life (QOL) for patients with psoriasis improved as the affected body surface area (BSA) decreased, according to data from the Corrona Psoriasis Registry.

The National Psoriasis Foundation Medical Board recently recommended a treat-to-target approach for psoriasis. However, the relationship between BSA improvement and QOL remained undefined. To evaluate the relationship, Jashin J. Wu, MD, of Kaiser Permanente in Los Angeles, and colleagues retrospectively reviewed data for 359 patients with baseline BSA >3% and 6- and 12-month follow-up data.

At 6 and 12 months, respectively, 40.4% and 47.6% of the patients had at least 75% improvement in BSA, including 26% and 36% who achieved the treatment target of BSA ≤1%. In a subgroup of 167 patients with greater QOL burden (DLQI >5), 66% had at least a 4-point improvement in DLQI -- defined as the minimally important clinical difference, or MCID -- at 6 months and 26% achieved a DLQI of 0 or 1 (P<0.001 vs baseline). At 12 months, 78% of patients met MCID criteria and 43% had DLQI scores of 0 or 1 (P<0.001).

At both 6 and 12 months, the MCID rate was higher in patients who had greater BSA improvement (P<0.001, P<0.003), greater BSA improvement was associated with greater DLQI improvement (P<0.001), and attainment of the BSA target of <1% was associated with greater DLQI improvement (P<0.001).

Treatment Discontinuation in Psoriasis Remains High

More patients who started psoriasis treatment with an injectable biologic agent remained on treatment for a year as compared with patients who started with an oral agent, but discontinuation rates were high in both groups, a study based on electronic medical record (EMR) data showed.

Of 5,900 patients who started treatment with etanercept (Enbrel) or apremilast (Otezla), about a third discontinued treatment within 6 months with no difference between groups. By 12 months, 67.6% of the etanercept group had discontinued, as had 73.2% of the apremilast group (P<0.001). Treatment augmentation rates were 15%-18% at 6 and 12 months. Rates of therapeutic switch were 8%-9% at 6 months and 15%-16% at 12 months.

Though patients persisted longer with etanercept than apremilast, discontinuation rates were high for both drugs, concluded Dionne M. Hines, of IQVIA in Plymouth Meeting, Pennsylvania, and colleagues. The EMR data provided few clues about reasons for discontinuation, an area that requires further study, they added.

Therapeutic Switch Boosts Response in Psoriasis

About 75%-80% of patients with psoriasis who did not meet criteria for clear/nearly clear skin with adalimumab (Humira) subsequently met the criteria when switched to guselkumab (Tremfya), a subgroup analysis of two randomized trials showed.

In the phase III VOYAGE 1 trial, 138 patients who did not achieve PASI 90 or PASI 100 status after 52 weeks on adalimumab switched to guselkumab. From week 52 to week 100, 73% of the patients attained PASI 90 status with guselkumab and 42% met PASI 100 criteria, reported Christopher E.M. Griffiths, MD, of the University of Manchester in England, and colleagues. An analysis by IGA status (0/1 = clear, almost clear) showed that 79% of patients attained IGA 0 or 1 by 100 weeks and 46% attained IGA 0 status.

Investigators repeated the analysis for VOYAGE II for 112 patients who switched from adalimumab to guselkumab. The results showed that 75% of the patients attained PASI 90 status by week 100 and 43% attained PASI 100 status. IGA results at 100 weeks were 81% for IGA 0/1 and 46% for IGA 0.

Quality of life response (DLQI) tripled after the switch to guselkumab in VOYAGE 1 and increased more than fourfold in VOYAGE 2. Similar improvement was seen in symptom improvement after the switch.