• Isabel Belinchón Romero, Esteban Dauden, Carlos Ferrándiz Foraster, Álvaro González-Cantero, and Jose Manuel Carrascosa Carrillo.
• Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, Spain.
• Ann. Med. 2021 Dec 1; 53 (1): 172717361727-1736.

ObjectiveTo critically analyse and define therapeutic objectives, response to treatment evaluation and related decisions in psoriasis.MethodsExpert consensus meetings, a systematic and narrative reviews and a collaborative Delphi procedure were carried out. A steering committee from the Spanish Group of Psoriasis was established who based on the reviews generated a set of related statements. Subsequently, a group of 40 experts tested their agreement with the statements, through 3 Delphi rounds.ResultsWe found a great variability in clinical guidelines regarding to the definition of treatment goal and the response. In general, treatment failure was considered if a PASI50 is not achieved. The panel of experts agreed on (1) clearly differentiate between ideal and a realistic goals when establishing the therapeutic goal in moderate to severe psoriasis; (2) treatment goals should be in general established regardless of the type of drug for psoriasis; (3) treatment failure if PASI75 response is not reached; (4) an absolute PASI is in general preferred to the rate of PASI improvement from baseline; (5) disease characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals.ConclusionsA clear treatment decision making framework is vital to improve management of psoriasis.KEY MESSAGESPsoriasis characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals.Different disease indexes could be used to assess treatment response but absolute PASI is preferredIn general psoriasis treatment failure should be considered if PASI75 response is not reached.

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