Some patients with psoriasis show a "super-response" to biologic therapy. Unfortunately, reports of super-response use varying definitions, making comparison of studies a challenge. Better standardization would make comparisons between different biologics easier.
Variations:
(1) measurement of response (most often based on PASI = Psoriasis Area and Severity Index)
(2) time measure for initial response
(3) maintenance/duration of response
Thomas et al recommend using both a relative and absolute measure of response:
(1) relative measure: PASI 90 (90% improvement in PASI) or PASI 100 (100% in PASI)
(2) absolute measure: such as PASI < 2
Time measure for response: at week 12, 16, 24 or 28
Maintenance of response: 6-month, 1 year, 2 years, 5 years
In general, a super-responder has:
(1) a significant improvement in the psoriasis initially
(2) able to maintain the level of improvement for some time.
In the end, the definition used depends on how inclusive or selective the semantics of the term should be. The most restrictive definition would be PASI 100 at 12 weeks with maintenance of PASI 100 for 5 years.
What may be needed is a score based on points assigned for different endpoints.
One other variable is the dose of the biologic being used during the maintenance period (no change, reduced, discontinued).
