Defining On-Treatment Remission in Plaque Psoriasis

Establishing a standardized definition of on-treatment remission in plaque psoriasis is essential for aligning expectations, guiding therapy, and enhancing disease management.¹ In a multistage Delphi initiative, experts and stakeholders reached consensus: remission is defined as maintaining 0% body surface area (BSA) involvement or an Investigator Global Assessment (IGA) score of 0 for at least 6 months while on treatment.

A new consensus from the National Psoriasis Foundation outlines a clear benchmark for remission to improve treatment decisions and patient outcomes. | Image credit: Milan Lipowski - stock.adobe.com

The findings were published in JAMA Dermatology.

“The aim of this Delphi exercise was to establish a definition of on-treatment remission in patients with plaque psoriasis for use in research and clinical practice,” wrote the authors of the consensus statement. “This effort is important for evaluating and benchmarking patient responses in comparing existing and future therapies. This definition entails maintaining the specified response level for a minimum predefined time period.”

Plaque psoriasis remission occurs when the skin clears and noticeable symptoms—such as scaling, redness, or itching—disappear.² Without a universally accepted definition of remission, its presentation and duration can vary significantly depending on the individual, the type of psoriasis, and skin tone.

For people of color, symptoms may appear differently, which can make assessing remission more complex and potentially impact how long it lasts. While remission may last from as little as 1 month to over a year, some individuals experience much longer symptom-free periods. This variability highlights the importance of a clear and consistent definition of remission to better guide treatment and patient expectations.

The objective of this initiative was to establish a consensus-based definition of on-treatment remission in plaque psoriasis to support consistent treatment goals and improve patient care.¹ To achieve this, the National Psoriasis Foundation’s Remission Workgroup conducted a multistage Delphi process involving a broad range of stakeholders, including US and international dermatologists, rheumatologists, researchers, patients, payers, and industry professionals. The process began with a systematic literature review to identify existing definitions of remission and inform the development of consensus materials. This was followed by pre-Delphi interviews and surveys to gather insights that shaped the formal Delphi questions.

Participants included individuals with both mild (54%) and moderate to severe (46%) plaque psoriasis, and 38% also had psoriatic arthritis. The group was 54% female, including African American (15%), Asian (23%), White (62%), and Hispanic or Latino (31%) individuals. In parallel, 38 additional stakeholders—including clinicians, researchers, life sciences professionals, and payers—completed tailored electronic surveys to contribute their perspectives.

A subsequent Delphi exercise with clinicians specializing in psoriatic disease management was used to refine and reach agreement on the criteria for on-treatment remission. The Delphi exercise that followed included 41 physicians, primarily dermatologists (81%), along with rheumatologists (17%) and 1 cardiologist.

Patients emphasized the importance of the complete absence of visible signs and symptoms while on therapy, reflecting a desire for meaningful, sustained relief. Payers highlighted the value of a standardized definition to support decisions around long-term treatment coverage. Clinicians participating in the Delphi exercise ultimately agreed that on-treatment remission should be defined as maintaining a BSA involvement of 0% or an IGA score of 0 for at least 6 months while continuing therapy. This definition represents a clinically meaningful and achievable goal, offering a clear benchmark for both routine care and future research.

“Through a Delphi consensus process, on-treatment remission for plaque psoriasis was defined as patients maintaining a BSA involvement of 0% or IGA of 0 for at least 6 months while on treatment. This clear and standardized benchmark is applicable to both research and practice settings.”

References

1. Armstrong AW, Gondo GC, Merola JF, et al. Defining on-treatment remission in plaque psoriasis: A consensus statement from the National Psoriasis Foundation. JAMA Dermatol. Published online June 18, 2025. doi:10.1001/jamadermatol.2025.1625

2. Dempsey B. What to know about psoriasis remission. WebMD. April 28, 2025. Accessed June 18, 2025. https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-remission