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Title:           Global Delphi consensus on treatment goals for generalized pustular psoriasis
Subject:         DOI: 10.1093/bjd/ljae491; British Journal of Dermatology, , , 23-1-2025.; Abstract
Background Generalized pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included and aspects of treatment goals remained unclear.
Objectives To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation.
Methods Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorized into overarching principles, and short- and long-term treatment goals. A global panel of 30 dermatologists and 3 patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥ 80% approval by the panellists.
Results Consensus was reached in the first round of voting and ≥ 90% agreement was reached for 23 of 26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (−4 or more points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritize GPP. Long-term treatment goals should include minimizing disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals (e.g. avoiding hair and/or nail loss to improve QoL), reflect the complexity of assessing treatment goals and emphasize the need for a patient-centred approach.
Conclusions In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, and short- and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of patients and physicians in the treatment of GPP.
Author:          Jonathan N  Barker; Emmylou  Casanova; Siew Eng  Choon; Peter  Foley; Hideki  Fujita; César  Gonzalez; Melinda  Gooderham; Slaheddine  Marrakchi; Luís  Puig; Ricardo  Romiti; Diamant  Thaçi; Min  Zheng; Bruce  Strober
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     Item: 
      Title: Global Delphi consensus on treatment goals for generalized pustular psoriasis
      Children: 
       Item: 
        Title: Materials and methods
       Item: 
        Title: Results
        Children: 
         Item: 
          Title: Systematic literature review
         Item: 
          Title: Demographics of the Delphi panellists
         Item: 
          Title: Delphi method findings
         Item: 
          Title: Overarching principles
         Item: 
          Title: Short-term treatment goals
         Item: 
          Title: Long-term treatment goals
       Item: 
        Title: Discussion
        Children: 
         Item: 
          Title: Acknowledgements
         Item: 
          Title: Funding sources
         Item: 
          Title: Conflicts of interest
         Item: 
          Title: Data availability
         Item: 
          Title: Ethics statement
         Item: 
          Title: Patient consent
       Item: 
        Title: Supporting Information
       Item: 
        Title: References
       Item: 
        Title: Appendix 1
        Children: 
         Item: 
          Title: Partnering for Innovation and Excellence in Rare Skin Diseases (PIONEERS®) Working Group and the DELPHI Panel
   Info: 
    Title: Global Delphi consensus on treatment goals for generalized pustular psoriasis
    Author: Jonathan N  Barker; Emmylou  Casanova; Siew Eng  Choon; Peter  Foley; Hideki  Fujita; César  Gonzalez; Melinda  Gooderham; Slaheddine  Marrakchi; Luís  Puig; Ricardo  Romiti; Diamant  Thaçi; Min  Zheng; Bruce  Strober
    Subject: DOI: 10.1093/bjd/ljae491; British Journal of Dermatology, , , 23-1-2025.; Abstract
Background Generalized pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included and aspects of treatment goals remained unclear.
Objectives To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation.
Methods Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorized into overarching principles, and short- and long-term treatment goals. A global panel of 30 dermatologists and 3 patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥ 80% approval by the panellists.
Results Consensus was reached in the first round of voting and ≥ 90% agreement was reached for 23 of 26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (−4 or more points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritize GPP. Long-term treatment goals should include minimizing disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals (e.g. avoiding hair and/or nail loss to improve QoL), reflect the complexity of assessing treatment goals and emphasize the need for a patient-centred approach.
Conclusions In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, and short- and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of patients and physicians in the treatment of GPP.
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Background Generalized pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included and aspects of treatment goals remained unclear.
Objectives To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation.
Methods Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorized into overarching principles, and short- and long-term treatment goals. A global panel of 30 dermatologists and 3 patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥ 80% approval by the panellists.
Results Consensus was reached in the first round of voting and ≥ 90% agreement was reached for 23 of 26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (−4 or more points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritize GPP. Long-term treatment goals should include minimizing disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals (e.g. avoiding hair and/or nail loss to improve QoL), reflect the complexity of assessing treatment goals and emphasize the need for a patient-centred approach.
Conclusions In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, and short- and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of patients and physicians in the treatment of GPP.</rdf:li>
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