For decades, the severity of psoriasis has been classified on the basis of thresholds reflecting the BSA, or body surface area, impacted by the condition. Under this classification, individuals with less than 3 percent of BSA were categorized as having mild psoriasis; those with a BSA ranging between 3 and 10 percent were regarded as having moderate psoriasis; while those with a BSA in excess of 10 percent were classified as having severe psoriasis.
This way of classifying psoriasis influences the prescription of systemic therapies, particularly biologics indicated for psoriasis. Many insurance firms require that a patient has a BSA in excess of 10 percent in order to qualify for coverage of their treatment using biologics. However, a recent study is bringing into question the thinking that low BSA indicates that the disease burden is lower for the patient.
The analysis, whose findings appeared in the journal Dermatology & Therapy, focused on the PROs (patient-reported outcomes) for individuals with varying BSA as captured in the Psoriasis Registry at CorEvitas. The patients studied hadn’t been on treatment before and they were just getting initiated onto biologic treatment. The data covered the 2015-2023 period.
The participants were grouped into the categories assigned on the basis of BSA. The team of researchers then examined factors like skin pain, itch, psoriatic arthritis screening, fatigue, quality of life and the history of psoriasis of the patients at the time they were being initiated on the biologic treatment.
The researchers found that higher BSA scores were more common among older men, and these men also tended to have diagnoses for more comorbidities like depression and obesity. Surprisingly, patients categorized as having mild psoriasis (low BSA) appeared to have more incidences of psoriatic arthritis compared to other BSA groups.
When the data was analyzed in terms of how patient-reported outcomes overlapped for the different BSA categories, they found that there was a high likelihood for patients with low BSA to have a greater or equal disease burden when compared to patients whose BSA was higher.
The findings strongly bring to light the need to avoid relying on just BSA when assessing the disease burden for a patient. Such an assessment needs to weigh other key factors, such as whether or not the patient has psoriatic arthritis, whether they have used topical treatments and those have failed to offer symptomatic relief, how their quality of life has been impaired by the disease, and whether high-impact sites (for example nails, scalp, soles, and palms) are affected by the condition. Keeping all these factors in mind would provide a clearer picture while making the decision to prescribe or not prescribe systemic treatments.
There is also a need to update the way insurance firms determine who can be covered for systemic treatment as this has implications on how many patients will be able to afford the treatment they require.
As the search to bring to market more efficacious treatments for psoriasis proceeds at companies like Soligenix Inc. (NASDAQ: SNGX), there is an urgent need to rethink how patients are assessed. The study in the discussion above shows how inadequate basing on BSA alone is.
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