Here’s an interesting, after-the-fact analysis from clinical trials of the biologic Ilumya (tildrakizumab-asmn), an “IL-23 inhibitor” marketed by Sun Pharma. The researchers looked at psoriasis severity scores used in clinical trials, known as PASI scores (Psoriasis Area and Severity Index), for each patient. Each patient’s score is determined before the first dose, and then at various points afterwards throughout the trial. That way, improvement (or worsening) can be tracked over time.

When they looked back at the data, they found that those who were 90% improved after six and a half months (28 weeks), were those who had improved at least 50% by week 4.

Conversely, those who went on to have less than a 50% improvement at week 28, were already trailing the others at week 8. (Only 8% of patients in the trials using the now-FDA approved dose [100 mg] failed to reach at least 50% improvement at week 28.)

This suggests a near-future when those destined to “fail” on a particular treatment can be moved earlier to a different option. This would help patients.

One complication is that very few dermatologists calculate PASI scores in “real life” – it is typically only used in clinical trials. Still, it could certainly be worth a try for a dermatologist starting a patient on Ilumya to calculate a PASI score at the outset and then see the patient at week 8 for assessment of the level of improvement.

“Personalized medicine” is coming. This analysis of the Ilumya data moves that day a bit closer.

A final note: for those of you who want to play doctor at home (cough), here is a link to a website that appears to have a free online form to help you calculate someone’s PASI score. WE DO NOT KNOW IF THIS WEBSITE (from lovely little Liechtenstein) IS LEGITIMATE, but we believe in treating our website visitors as adults and letting you make these decisions. Kids, ask your parents first! Here is the PASI website. It generally takes practice to become skilled at calculating PASI scores accurately, but have at it if you wish. And if you are not a physician, remember you are getting a rough estimate for fun, not to actually make treatments decisions on!

[Last updated 11-5-2019]