Time to Raise the Bar to Psoriasis Area Severity Index 90 and 100

October 2015 | Volume 14 | Issue 10 | Editorials | 1086 | Copyright © October 2015

Iviensan F. Manalo BS,a Kathleen E. Gilbert BS,b and Jashin J. Wu MDc

aGeorgia Regents University Medical College of Georgia, Augusta, GA
bIndiana University School of Medicine, Indianapolis, IN
cDepartment of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA

table 1
patients with greater PASI improvement scores. Furthermore, the PASI 90 benchmark is able to identify significant efficacy disparities within the same agent. Secukinumab’s 300 mg dose showed more favorable PASI 90 and 100 response rates and correspondingly greater DLQI improvement compared with the 150 mg dose, supporting recommendations for its 300 mg dose.5

Conclusions and Areas for Further Research

As we become more proficient at treating psoriasis with significantly higher and faster PASI responses, our benchmarks for therapeutic success must evolve as well. Given that anti-IL-17 agents have already demonstrated significant superiority over etanercept and ustekinumab and that the first of the anti-IL-17 agents is now approved with sustained efficacy and safety after 2 years,19 we must now increase our clinical efficacy expectations to PASI 90 and beyond. Of course, as we continue to strive for patient-centered care, management should remain multi-dimensionally catered to individual patients’ preferences on efficacy, cost, convenience, and safety. We encourage dermatologists and third-party payers, however, to recognize the significant improvement in PROs in PASI 90 and 100 responses compared with PASI 75 and the significantly higher and faster response rates of the anti-IL-17 agents compared with the previous generation of biologics. Even in the longest duration of reported results for ixekizumab (60 weeks), significantly high proportions of patients maintained robust response rates and favorable safety profiles.20 With consistent long-term results of these agents, PASI 90 and 100 should become the new benchmarks of therapeutic success for future systemic agents to be effectively compared
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Dr. Wu received research funding from AbbVie, Amgen, AstraZeneca, Coherus Biosciences, Dermira, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, Sandoz, and Sun Pharmaceutical Industries; he is a consultant for AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Pfizer, and Sun Pharmaceutical Industries. The other authors do not have any potential conflicts of interest.


  1. Al-Suwaidan S, Feldman S. Clearance is not a realistic expectation of psoriasis treatment. J Am Acad Dermatol. May 2000;42(5 Pt 1):796-802.
  2. Krueger G, Papp K, Stough D, et al. A randomized, double-blind, placebo-controlled phase III study evaluating efficacy and tolerability of 2 courses of alefacept in patients with chronic plaque psoriasis. J Am Acad Dermatol. Dec 2002;47(6):821-33.
  3. Lebwohl M, Tyring S, Hamilton T, et al. A novel targeted T-cell modulator, efalizumab, for plaque psoriasis. N Engl J Med. Nov 2003;349(21):2004-13.