When you start a new psoriasis treatment, it can be tough to know what to expect. How long before it starts to work? How much improvement can you hope to see? At what point should you try something new? To help answer these questions, NPF issued a clear set of treatment goals for everyone with psoriasis and their health care providers called “Treat to Target.” The recommendations were published in November 2016 in the Journal of the American Academy of Dermatology.
Q: What is “Treat to Target”?
These are the first psoriasis treatment targets to be published in the United States. The purpose of these targets is to set goals and a new standard of care for those who have psoriasis. While these were the first treatment targets in the U.S. in dermatology, they are by no means the first treatment targets in the U.S. for other diseases. Many people are aware of targets that exist to monitor things like blood pressure and diabetes. The goal of these treatment targets is to help patients and their providers to make treatment decisions, reduce disease burden and improve the ultimate health outcomes for that patient.
Q: What are the targets?
The preferred tool to measure the target for psoriasis is body surface area (BSA). When it comes to timing, the consensus among the experts is that patients should be evaluated three months after starting a medication. What we hope to see is a BSA of less than 1 percent (roughly equal to the surface of your palm). But we’re aware that some medications work a little faster and some a little slower. Now, it’s also acceptable if, after three months, a patient’s BSA is less than 3 percent (three palms), or if the patient’s BSA has improved by 75 percent.
The reason there’s this type of “and/or” approach is that when a patient’s psoriasis is very extensive, getting to 1 percent or less might be a little bit harder than for somebody whose disease, while still severe, might be very much less than that first patient. Then at the six-month visit, everybody should be at 1 percent body surface area or less.
(Editor’s note: If you are not meeting treatment targets, do not get discouraged. Talk to your health care provider about your treatment options. You may decide with your provider to change your dose, add a treatment, or switch to a new treatment. Remember, there are many treatment options for psoriasis. Keep working with your doctor to find the one that will help you hit your target.)
Q: My psoriasis has progressed to the point that I am now considering a biologic. What is the safest one, and can you comment on the newer medications?
I tell my patients that the safest medication is the one that you as an individual patient tolerate well. If you’re thinking about a biologic because your disease is severe, then the risks of the medication get interpreted through that lens. I don’t think any of us who have a dime-sized amount of psoriasis only on their elbow would be thinking about an oral or biologic medication. But I think all the biologic medications in general are very well-tolerated and most of my patients do extremely well with them.
With all of them, we worry about the risk of infection. There are lots of others that show up in the package insert that occur very uncommonly, but the main risk that I think patients need to be thinking about is the risk of infection. We believe — for psoriasis patients — the risk tends to be fairly small. I think all of these biologic medications are quite safe, they just have slightly different safety risks. So I think the risks of each of these medications have to be interpreted in terms of you as a unique individual, along with the medical problems you may or may not have. That is critical for your provider to be thinking through as they make choices about what medication is truly the safest in your unique situation.
(Editor’s note: It is important to discuss the benefits and the risks associated with any treatment plan with your health care provider.)
Abby Van Voorhees, M.D., is chair of dermatology at Eastern Virginia Medical School in Norfolk, Virginia. She is also the chair of NPF’s Medical Board and was one of the lead authors of the Treat to Target paper published in the Journal of the American Academy of Dermatology.
Learn more about Treat to Target
Get the latest treatment guidelines and outlines to meet specific health goals with NPF's Treat to Target.
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