Mrowietz 2011 — European treat-to-target consensus for moderate-to-severe psoriasis
Citation
Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CEM, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res. 2011 Jan;303(1):1–10. DOI: 10.1007/s00403-010-1080-1. PMID 20857129.
Study design and population
European expert consensus. 4-round Delphi + face-to-face meeting; 19 dermatologists from 19 European countries. Defines treatment goals for adult moderate-to-severe plaque psoriasis on systemic therapy.
Reported outcomes
- Post-induction rule: ΔPASI ≥ 75 % → continue
- ΔPASI 50–< 75 % with DLQI ≤ 5 → continue; otherwise modify
- ΔPASI < 50 % → modify therapy
- DLQI ≤ 5 as the patient-relevant QoL anchor
Surrogate-to-outcome linkage
Explicitly couples PASI severity-score change with DLQI-defined QoL improvement as the joint trigger for treatment continuation vs. escalation. Canonical codification of the severity-score → treatment-optimisation → PRO benefit chain. Directly underpins the clinical-utility argument that tighter severity tracking (e.g., AI-assisted) drives better treatment titration and downstream outcomes.
CRIT1–7 appraisal
| Criterion | Score | Justification |
|---|---|---|
| CRIT1 Relevance | 3 | Direct — defines the operational severity → treatment-decision → PRO rule. |
| CRIT2 Methodology | 2 | Structured 4-round Delphi; European multi-national expert panel. |
| CRIT3 Reporting | 3 | Decision thresholds explicitly stated. |
| CRIT4 Applicability | 3 | EU context, directly applicable. |
| CRIT5 Evidence weight | 2 | European consensus guideline (not RCT, not meta-analysis). |
| CRIT6 Risk of bias | 2 | Consensus rather than primary data; industry relationships disclosed. |
| CRIT7 Contribution | 3 | Core anchor for the treatment-titration channel of the severity-scoring argument. |
Aggregate: strong.
Limitations and notes
Pre-dates IL-17 / IL-23 biologic era where PASI-90 / PASI-100 thresholds now predominate.
Strength as anchor
Strong — the operational link between severity score and treatment decision, explicitly coupled to HRQoL. Without Mrowietz 2011, the "tighter severity tracking improves outcomes" claim relies on inference rather than a codified rule.