Original articlePhysician 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
Section snippets
Methods
We investigated how well the PGA correlates with the PASI to determine whether or not they provide redundant clinical information regarding disease severity. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for performing a systematic review, a literature search protocol was developed. The Ovid MEDLINE database was used to search for randomized controlled trials for 7 biologic therapies, phototherapy, cyclosporine, and methotrexate. The search terms
Results
Of the 123 studies reviewed, 30 met inclusion criteria. In general, studies of the nonbiologic drugs performed before 2000 did not use both PASI and PGA as assessment tools. There was only one study of a topical therapy that did report the percentage of patients achieving a PGA 0,1 and PASI 75.38 Thus, our results were limited to 30 randomized controlled trials of biologic drugs from 2001 through 2010. The percentage of patients achieving a PASI 75 was compared with the percentage of patients
Discussion
The PASI is the most commonly used and best validated psoriasis severity assessment tool. However, the majority of clinical trials performed within the past 10 years for moderate to severe psoriasis use both the PASI and PGA as measures of severity. This may in part be a result of recommendations from the FDA that accept the PASI, but emphasize its shortcomings. The two assessment tools have previously been compared directly in a single trial and found to correlate well.39 The results of this
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Funding sources: National Psoriasis Foundation/USA.
Conflicts of interest: None declared.