Researchers working in clinical trials for psoriasis should standardize the use of psoriatic arthritis screening tools in all patients, according to recommendations based on an online survey and consensus meeting results organized by the International Dermatology Outcomes Measures initiative.
“Psoriasis studies are often carried out by non-rheumatologists and access to rheumatologists in the conduct of a psoriasis study is limited and often thought to be outside the scope of a psoriasis skin study,” Lourdes Maria Perez-Chada, MD, MMSc, a clinical research fellow at Brigham and Women’s Hospital, and colleagues wrote. “While these barriers do present some challenges, screening for [psoriatic arthritis] in the at-risk psoriasis population is not only consistent with good clinical practice but further represents a key opportunity to detect an important comorbidity of disease.”
The International Dermatology Outcomes Measures (IDEOM) initiative examines the need for standardized, clinical outcome measures. The group is developing a Core Outcome Set, which is the minimum set of outcomes to be measured and reported in all clinical trials for a specific disease-state.
To build consensus on the most appropriate psoriatic arthritis (PsA) symptoms instrument, IDEOM members created an online Delphi survey and held a consensus meeting with 40 stakeholders made up of patients, physicians and other health care providers from North America, South America, Europe, Asia, Australia and Africa.
All 329 members of IDEOM were invited to participate by email, along with 965 members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and 47 members of the Psoriasis and Psoriatic Arthritis Clinics Multicenter Consortium Network.
Of 297 experts who completed the survey, 45.1% were rheumatologists, 26% were dermatologists, 7.4% were patients, 8.8% were industry partners, 5.1% were dermatologist-rheumatologists, 3.4% were patient association representatives, 0.3% were from a nonprofit dermatology or organization partner and 3.7% were identified as other respondents.
Of the 297 participants, 91.2% agreed that all patients enrolling in a psoriasis trial should be asked about a rheumatologist-diagnosis of PsA and 87.5% agreed that all patients enrolling in a psoriasis trial should be screened for PsA, whether or not there is a known diagnosis.
The Psoriatic Arthritis Impact of Disease-9 (PsAID9) was voted the instrument of highest quality and achieved the most votes as the first choice for measuring symptoms in PsA. The Routine Assessment of Patient Index Data-3 (RAPID3) achieved the highest number of votes as a second-choice instrument.
In the consensus meeting after the survey, 77% of attendees agreed that PsA screening should be included in all psoriasis trials and that no further Delphi rounds were needed.
Measuring PsA symptoms during longer studies may provide insight into how dermatological therapies might affect the PsA component of disease, according to the authors. – by Abigail Sutton
Disclosures: Perez-Chada reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.