Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): Why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis
Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): Why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis
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DOI：
10.1016/j.jaad.2011.01.022
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发表时间：
2012-03-01
影响因子：
13.8
通讯作者：
Kimball, Alexandra B.
中科院分区：
文献类型：
--
作者：
Robinson, Amanda;Kardos, Marisa;Kimball, Alexandra B.
背景：虽然目前发表了许多牛皮癣评估工具，但牛皮癣研究中尚未满足的需求之一是对单一的最佳验证和可重复的评估工具的共识。目的：在本系统综述中，我们试图确定两种常用的牛皮癣评估工具，牛皮癣面积和严重程度指数（PASI）和医生整体评估（PGA）之间的相关性程度。方法：使用系统评价和荟萃分析指南的首选报告项目对中度至重度牛皮癣的随机对照系统试验进行综述。我们记录并比较了在研究药物治疗8至16周、17至24周和超过24周时PASI评分（PASI 75）和PGA 0或1（明确或几乎明确）降低75%的患者的百分比。结果：我们的文献回顾了30个随机对照试验，使用生物制剂治疗中度至重度牛皮癣。我们发现除了治疗效果的下限外，这两种评估工具的相关性非常紧密。PASI 75与PGA清晰或几乎清晰评分的相关性r(2)值在8至16周时为0.9157，在17至24周时为0.892。局限性：本研究的局限性包括少数随机对照试验，这些试验公布了24周治疗后PASI评分降低75%的患者百分比和PGA评分明确或几乎明确的患者百分比。此外，我们的结果不能推广到中重度斑块型银屑病患者。结论：这两种评估工具基本上是冗余的，单独使用任何一种都是评估中重度牛皮癣严重程度的足够工具。因为PASI是更好的验证和更详细的，它仍然是临床试验的选择分数，但更简单的PGA可能更适合基于社区的结果项目。[J] .中华皮肤科杂志，2012;66:369-75。]
Background: Although there are many psoriasis assessment tools currently published, one of the unmet needs in psoriasis research remains consensus about the single best validated and reproducible assessment tool.Objectives: In this systematic review we sought to determine the degree of correlation between two commonly used psoriasis assessment tools, the Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA).Methods: Randomized controlled systemic trials in moderate to severe psoriasis were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We recorded and compared the percent of patients achieving both 75% reduction in PASI score (PASI 75) and PGA 0 or 1 (clear or almost clear) at 8 to 16 weeks, 17 to 24 weeks, and greater than 24 weeks of treatment with the investigational drug.Results: Our literature review yielded 30 randomized controlled trials using biologic agents in moderate to severe psoriasis. We found that the two assessment tools correlate very tightly except at the lower bounds of therapeutic efficacy. The r(2) values for the correlation between PASI 75 and a score of clear or almost clear on the PGA were 0.9157 at 8 to 16 weeks and 0.892 at 17 to 24 weeks.Limitations: Limitations of our study include the small number of randomized controlled trials publishing the percent of patients achieving 75% reduction in PASI score and a score of clear or almost clear on the PGA after 24 weeks of therapy. In addition, our results are not generalizable beyond the patients with moderate to severe plaque psoriasis.Conclusion: The two assessment tools are substantially redundant and either alone is a sufficient tool for assessing psoriasis severity in patients with moderate to severe disease. Because the PASI is better validated and more detailed, it remains the score of choice for clinical trials, but the simpler PGA may be well suited for community-based outcomes projects. (J Am Acad Dermatol 2012;66:369-75.)