P045 An international Delphi consensus to define a clinically appropriate definition of disease modification for plaque psoriasis
Bibliographic record
Abstract
Abstract In moderate-to-severe psoriasis, biologic therapies have achieved high levels of complete skin clearance and maintenance of this response over several years for many patients. However, questions remain as to how the disease can be controlled, brought into remission, or modified. Current definitions and measurement of disease modification are of limited utility in a clinical setting. This work acknowledges that the rapidly developing therapeutic landscape for plaque psoriasis brings into focus the question of potential for disease modification. Our objective was to achieve consensus on a definition of disease modification that can be applied within a clinical setting. In May 2021, a literature review on the topic of disease modification in psoriasis was conducted using the PubMed database. Search terms included but were not limited to ‘disease modification’, ‘disease progression, ‘disease interception’, ‘treatment target’, ‘drug therapy’, ‘biomarker’ and ‘drug-free remission’. Following the review, a panel of experts in psoriasis care from across Europe and North America convened in October 2021. Employing Delphi methodology guided by an independent facilitator, the panellists identified six main topics of focus. These topics were discussed, and 35 statements were developed and used to inform an online Delphi survey. This was distributed through a convenience sampling method to 97 healthcare professionals specializing in psoriasis care across Europe and North America. Respondents were offered a four-point Likert scale to indicate their responses. Completed surveys were anonymously collated and analysed by the independent facilitator. The results were then shared with the expert panel to determine conclusions. Stopping criteria for consensus rounds were defined as a 3-month period to collect responses, a minimum of 50 responses within this timeframe, and 90% of statements passing the threshold for consensus. The a priori threshold for consensus agreement was set at 75% and was further defined to be ‘very high’ at ≥ 90%. In total 63 responses (65% response rate) were received. Consensus was achieved for 32 statements and was not achieved for three statements. Given the high level of agreement with the statements, and that the stopping criteria were met, a second round of testing was not performed. The authors offer a definition of disease modification for plaque psoriasis that could be utilized in a clinical setting: ‘A sustained improvement in the disease course of plaque psoriasis resulting from a change in pathophysiology that minimizes the need for treatment.’ To determine the strength of this definition, the next step will be to test it within a real-world clinical setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.299 | 0.243 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.007 | 0.004 |
| Science and technology studies | 0.005 | 0.009 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.004 | 0.019 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".