PS12 Psycholag in moderate-to-severe psoriasis: insights from the POSITIVE study on psychological wellbeing and treatment with tildrakizumab

Abstract

Moderate-to-severe psoriasis can profoundly impact mental health, and a delay between physical and psychological improvement in patients with skin disease has been described as ­‘psycholag’. However, this phenomenon has been barely explored in the context of biologic therapies in psoriasis. We evaluated whether patients with moderate-to-severe psoriasis treated with tildrakizumab experience psycholag by comparing improvements in skin vs. psychological wellbeing during 104 weeks of treatment. POSITIVE is a 24-month phase IV multicountry observational study in adult patients with moderate-to-severe plaque psoriasis treated with tildrakizumab in a real-world setting. The study is funded by Almirall. Psoriasis Area and Severity Index (PASI) and WHO-5 Well-Being Index were used to assess clinical effectiveness and psychological wellbeing, respectively. A WHO-5 score ≥ 64 (European population average) indicates psychological wellbeing control; PASI ≤ 2 indicates skin control. The study included 171 patients with WHO-5 < 64 and PASI > 2 at baseline. At week 16, 56 patients (32.7%) achieved both psychological wellbeing and skin control: WHO-5 increased from 45.9 to 75.4 and PASI decreased from 14.5 to 0.7. Notably, 51 patients (29.8%) achieved similar skin control (PASI change from 12.4 to 0.9) but still had impaired psychological wellbeing (WHO-5 change from 37.1 to 44.6). Nineteen (37%) of these experienced psycholag within the first 52 weeks: 13 had improved psychological wellbeing by week 28 (WHO-5 score 72.0) and 6 by week 52 (WHO-5 score 76.7). Over 52 weeks, skin control was maintained in 27 patients, while psychological wellbeing showed only slight improvement (WHO-5 score 40.1). The POSITIVE study demonstrates that tildrakizumab improves both physical symptoms and psychological wellbeing within 16 weeks in most patients. However, psycholag was exhibited by some patients. When evaluating treatment success in skin disease, psychological parameters should be measured alongside physical outcomes to enhance people-centred healthcare.