The Impact of Biologic Therapy on Health-related Quality of Life in Pediatric Psoriasis

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Pediatric psoriasis is a chronic, multisystem, inflammatory disease that primarily affects the skin, with a worldwide disease prevalence of roughly 1%. Pediatric psoriasis, compared to other pediatric skin diseases, reports some of the greatest impairments on health-related quality of life (HRQoL). Psoriasis causes a greater negative impact on HRQoL in pediatric patients than in adults. There is an overall paucity of data in the pediatric psoriasis patient population. Because FDA-approved treatment options are limited, this study reviews HRQoL results from Phase III randomized controlled trial (RCT) data from any biologic product that has data in pediatric psoriasis patients. It also assesses the feasibility of completing an indirect treatment comparison (ITC) of the HRQoL results. A systematic literature review following PRISMA and Cochrane recommendations and using PubMed MEDLINE and Ovid was done using relevant terms. The search identified three RCTs in the pediatric psoriasis population that used the Children’s Dermatology Life Quality Index (CDLQI) as a secondary outcome measuring impact on HRQoL. Two of the RCTs – one for etanercept and one for ustekinumab – used placebo as the comparator, and while the limitations required an ITC to be exploratory only, a comparison could be made as to the relative effectiveness of each intervention on CDLQI score. Ustekinumab showed numerical, but not statistically significant, superiority versus etanercept in improvement of CDLQI score. The relative improvement was more than the minimal clinically important difference. In conclusion, there is a need for more research into pediatric psoriasis and especially the effect of its treatments on health-related quality of life. In the absence of direct evidence of comparative effectiveness, it is difficult for prescribers, payers, and patients and caregivers to know which treatment will provide the best outcomes.



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