Evaluation of the efficacy of systemic treatments through psoriasis quality and function of life in patients with psoriasis and factors affecting continuity of treatment

Objectives: Psoriasis, which is a chronic disease, the quality of life can be significantly impaired due to the accompanying symptoms such as itching and inflammation, the visible areas can be affected, there may be joint involvement and the need for long-term treatment. Systemic treatments provide rapid clinical recovery of the disease, prevent comorbidities and recommended from the early period in moderate to severe disease in order to improve the quality of life. The objectives of this study is to evaluate the factors affecting the choice of treatment, the factors that cause the treatment cutoff, the effectiveness of the selected treatments and the effects of the treatments on the quality of life in patients who started systemic therapy. Material and Methods: In our study, 84 women, 66 men, 150 patients with systemic treatment indications diagnosed as moderate to severe psoriasis vulgaris were included. Patients were followed up prospectively for 24 weeks. Psoriasis severity index, dermatological quality of life index, psoriasis dysfunction index, psoriasis quality of life scale were recorded in patients evaluated at week 0, week 12 and week 24. Demographic data, accompanying comorbidities, previous treatment choices and reasons for treatment cessation, factors affecting treatment choice and special site involvement were evaluated. Results: The mean age of the patients was 42.55 ± 13.95 years, average disease duration was found as 13.56 ± 13.88 years. %43.3 of the patients had family history pf psoriasis, in which onset of the disease under 18 years of age was found statistically significant. %48 of the patient has dyslipidemia and %31.4 of patients had heart disease as the leading comorbidities seen with psoriasis. %30.7 of patientshad psoriatic arthritis. It was statistically significant results that biologic agents were preferred more often in patients with disease duration longer than 10 years, BMI > 30, with psoriatic arthritis, PASI > 20, DLQI > 10 and history of dyslipidemia. The reduction in PASI scores at the 12th and 24th weeks compared to pretreatment was statistically significant. PASI 90 and PASI 100 responses were significantly higher in patients who received biological therapy at week 24 compared to patients receiving conventional therapy. Patients having a diagnosis of psoriatic arthritis, disease duration longer than 10 years and BMI ≥ 30 had higher PASI scores correlated with disease severity. Statistically significant improvement observed in functionality assesed with PDI and quality of life assesed with DLQI and PLQI at 12th and 24th weeks of treatment. Patients who were initiated on biologic agent therapy on week 0 demonstrated higher DLQI and PLQI scores, and more effect of therapy on quality of life; while it was observed that patients in this group had more significant increase in their quality of life at week 12 and week 24 post therapy. It was found that quality of life of the patients suffering from psoriatic arthritis, having disease duration longer than 10 years and married patients was more effected. Patients having psoriatic arthritis had higher PDI scores compered to the patients not having psoriatic arthritis. Statistically significant decrease in initial DLQI, PDI, PLQI scores and improvement in functionality and quality of life were observes in patients who had 75 ≤ PASI < 90, 90 ≤ PASI < 100 at 12th week and 75 ≤ PASI < 90, 90 ≤ PASI < 100 , PASI 100 at 24th week. Quality of life and functionality in patients with more severe disease initialy and who had PASI >20 were more effected and improvement in these parameters was higher compered to the patients who had PASI scores of 10-20. Patients under the treatment of secukinumab had lower PASI scores at 12th week compered to the ones under the treatment of adalimumab or ustekinumab, however there was no difference at 24th week. It was found that there was a higher decrease in DLQI scores with secukinumab treatment at 12th week, yet there was no difference among biologic agents at 24th week. Conclusions: It has been observed that the quality of life of psoriasis patients is significantly impaired compared to the healthy population, they may experience loss of function in daily life and professionally. Comorbidities, psoriatic arthritis, disease duration and disease severity are effective in the choice of treatment. In our study, it was observed that all systemic treatments helped to improve disease severity, quality of life and function, in accordance with the literature,especially in patients with more affected, biological treatments were more effective and their effects appeared earlier. Key Words: Psoriasis, plaque psoriasis, conventional systemic treatments, biological agent treatments, quality of life, PASI, DLQI, PDI, PLQI.