Defining On-Treatment Remission in Plaque Psoriasis: A Consensus Statement From the National Psoriasis Foundation

April W. Armstrong, Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles.
George C. Gondo, National Psoriasis Foundation, Alexandria, Virginia.
Joseph F. Merola, Division of Rheumatology, Departments of Dermatology and Medicine, O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas.
Alyssa M. Roberts, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu.
Lourdes M. Pérez-Chada, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Deepak M. Balak, Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.
Guy S. Eakin, National Psoriasis Foundation, Alexandria, Virginia.
Charlotte Read, Department of Dermatology, University of Southern California, Los Angeles.
Stephanie T. Le, Department of Dermatology, University of California, Davis School of Medicine, Sacramento.
Yasmin Gutierrez, Department of Medicine, University of California, Riverside School of Medicine, Riverside.
Tina Bhutani, Department of Dermatology, University of California, San Francisco, San Francisco.
Andrew Blauvelt, Blauvelt Consulting LLC, Annapolis, Maryland.
Kristina Callis Duffin, Department of Dermatology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City.
Steven Fakharzadeh, Janssen Pharmaceutical Companies of Johnson & Johnson, LLC, Horsham, Pennsylvania.
Steven R. Feldman, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Joel M. Gelfand, Department of Dermatology and Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Sciences in Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Dafna D. Gladman, Schroeder Arthritis Institute, Krembil Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Brad Glick, Glick Skin Institute, Margate, Florida.
Lawrence J. Green, Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia.
George Han, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Jason E. Hawkes, Oregon Medical Research Center, Portland, Oregon.
Samuel T. Hwang, Department of Dermatology, University of California, Davis School of Medicine, Sacramento.
Nicole Johnsen, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles.
Robert E. Kalb, Department of Dermatology, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo.
Leon Kircik, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
Richard G. Langley, Division of Dermatology, Dalhousie University, Halifax, Nova Scotia, Canada.
Mark G. Lebwohl, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
G Michael Lewitt, Illinois Dermatology Institute, Chicago, Illinois.
Emanual Maverakis, Department of Dermatology, University of California, Davis School of Medicine, Sacramento.
Ronald Prussick, Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia.
Soumya M. Reddy, Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York.
Cheryl F. Rosen, Division of Dermatology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Document Type

Journal Article

Publication Date

6-18-2025

Journal

JAMA dermatology

DOI

10.1001/jamadermatol.2025.1625

Abstract

IMPORTANCE: Defining on-treatment remission in plaque psoriasis is important for benchmarking patient responses to therapies. This also helps to facilitate shared understanding, align treatment expectations, and enable more effective psoriasis management. OBJECTIVE: To establish a consensus-based definition of on-treatment remission for plaque psoriasis through a multistage Delphi initiative. EVIDENCE REVIEW: The Remission Workgroup from the medical board and scientific advisory board of the National Psoriasis Foundation engaged various stakeholders, both US based and international, to participate in the consensus process. Following a working group meeting to determine the overall consensus approach, a systematic review of remission definitions in the current literature was performed. This review helped to inform the content of consensus materials. The consensus effort involved 2 stages: pre-Delphi interviews and surveys to inform the Delphi questions, followed by a Delphi exercise with physicians to define on-treatment remission for plaque psoriasis. Outcome measures considered included body surface area (BSA), Investigator Global Assessment (IGA), the product of the Physician Global Assessment and body surface area (PGA × BSA), and Psoriasis Area and Severity Index (PASI) score at various cutoff levels and time points. FINDINGS: The consensus process involved 92 stakeholders, including dermatologists, rheumatologists, researchers, patients, payers, and life sciences professionals. In the pre-Delphi interviews and surveys, patients emphasized that on-treatment remission meant the absence of psoriasis signs and symptoms while recieving therapy. Payers expressed that defining remission is important for long-term treatment coverage. Following the Delphi exercise and discussion with participating physicians specializing in psoriatic disease management, on-treatment remission in plaque psoriasis was defined as patients maintaining a BSA of 0% or IGA of 0 for at least 6 months while on treatment. CONCLUSIONS AND RELEVANCE: Through a Delphi consensus process, on-treatment remission for plaque psoriasis was defined as patients maintaining a BSA involvement of 0% or IGA of 0 for at least 6 months while on treatment. This clear and standardized benchmark is applicable to both research and practice settings.

Department

Dermatology

Link to Full Text

Share

COinS