Krishna, S. (2008). Monitoring of the efficacy of immunobiologics in psoriasis. PHILICA.COM Observation number 48.
Monitoring of the efficacy of immunobiologics in psoriasis

Sreedhar Krishnaconfirmed user (Faculty of Medicine, University of London Imperial College)

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Psoriasis is a common, chronic, disfiguring inflammatory condition of the skin involving both genetic and environmental factors in its pathophsyiology. Up until recently, treatment of this condition has centred around topical treatments, phototherapy and generalised immunosuppression. However, with the advent of new immunobiologics, targeting either Tumor Necrosis Factor (TNF) or T-cells/Antigen presenting cells (APC), there is new hope for sufferers.

Unfortunately, these treatments are prohibitively expensive, starting at around $10,000 per annum. Currently, rationalising the use of such expensive agents falls upon two indices: The PASI (Psoriasis Area Surface Index) and DLQI (Dermatology Life Quality Index). While it can be agreed that both the PASI and DLQI are useful indicators of treatment response, they are in my opinion, quite severely lacking. As many sufferers will attest, psoriasis has terrible psychological, social and emotional consequences.

The busy dermatologist of today is time-constrained to use any index to use at all – let alone both of these clumsy, unwieldy measures. However, it is only by robust, uniformly periodic monitoring that we can assess the value of these novel agents.

An alternative, simplified version incorporating all facets of this pervasive disease needs urgent consideration - only then will we know how truly effective these treatments are.

Information about this Observation
Peer-review ratings as of 11:33:59 on 24th Feb 2018 (from 2 reviews, where a score of 100 is average):
Originality = 150.00, importance = 162.50, overall quality = 162.50

Published on Saturday 23rd August, 2008 at 21:08:12.

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The full citation for this Observation is:
Krishna, S. (2008). Monitoring of the efficacy of immunobiologics in psoriasis. PHILICA.COM Observation number 48.

Peer review added 14th October, 2008 at 19:09:46

I came across this obersvation qhilst searching for efficacy indices in psoriasis. Having read this short observation, I could not agree more: Looking through patient records and seeing no evidence of periodic treatment monitoring baffles me! How on earth is the clinician/funding authority meant to justify expensive treatment otherwise?!

Peer review added 30th September, 2011 at 16:03:18

The observation raises a practically important problem for the psoriasis patients.
The points made by the author in this observation are indeed worthwhile considering and addressing. NIRFS may offer an effective and economical means for monitoring the effects of treatment but will need an adequate and robust calibration by a primary method; the advantage of NIRFS would be the very low cost per measurement compared with most other techniques, and would also allow continuous, non-invasive monitoring of psoriasis patients undergoing treatments such as those specified in this observation. NIRFS might also support the development of new psoriasis treatments. (See also: Early Diagnosis of Alzheimer’s Disease by FT—NIRS, Fluorescence Microspectroscopy and Nuclear Medicine. In: medi.PHILICA.COM, Article number 268 ; 22nd August, 2011).

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