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People with psoriasis who took biologics saw improvements in quality of life as well as their symptoms, a recent literature review concluded.

The review, published in , examined nine studies comprising 20 patients and covering six biologics: adalimumab, alefacept, etanercept, infliximab, ustekinumab, and secukinumab. Six of the studies measured the change in Dermatology Life Quality Index (DLQI) -- a scale of 0-30 that accounts for relationship satisfaction and social activity, among other factors.

Twenty two sub-analyses were performed in these six studies: 20 of these showed DLQI improvement of ≥5 points on a scale of 0-30. In two of the three remaining studies, DLQI improvement was more pronounced with biologics than with systemic therapy. Two studies on adalimumab and etanercept did not find ≥5 points of DLQI improvement, but the result was statistically negligible.

Study co-author, Thomas Rustemeyer, DR, professor of dermatology and inflammatory diseases with Amsterdam University Medical Center in the Netherlands, discussed the review and its findings with the Reading Room. The exchange has been edited for length and clarity.

Why was this an important review for patients with psoriasis and their providers?

Rustemeyer: We know biologics can resolve the skin disease of psoriasis, but what about the disease's impact on quality of life? Getting a better understanding of this is really how we can change the life of the patient.

Biologic therapies are expensive -- much more so than traditional systemic therapy. The costs range from $13,000 to $30,000 per patient, and so it becomes important to research whether quality of life improves significantly with the use of these drugs.

So the aim of this systematic review was to investigate the effects of biologics on DLQI in patients with psoriasis.

What was the review's primary conclusion?

Rustemeyer: A lot can be achieved with biologics in treating psoriasis. And as we showed, it's much more than the skin. Biologics can give patients back their lives.

Biologics essentially remove fear and anxiety. Everything is kind of reset back to normal from a quality-of-life perspective.

Is quality of life misunderstood or overlooked by clinicians who treat people with psoriasis?

Rustemeyer: These are "soft" outcomes, which include things like quality of life or anxiety. But they are not always included in regular practice.

How can clinicians better account for quality of life in this patient population?

Rustemeyer: The good news is that in the past few years, those soft outcomes have started gaining more attention. It's so important to understand the well-being of the patient and what can be achieved besides curing the skin.

More attention should be paid to the quality of life of psoriasis patients. The DLQI questionnaire can be used for this. Patients can complete a questionnaire before starting a biologic and again after a few weeks or months. For the individual patient, it is then possible to understand how quality of life may improve. As a result, more patients will use these biologics as recommended, and this will improve the physician-patient relationship.

Clinical implications

• Biologics can substantially improve quality of life in patients with psoriasis.
• DLQI is an easy and effective tool for assessing quality of life in these patients.