CRYSTAL Real-World Study Explores State and Severity of Psoriasis in Greece

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The CRYSTAL-Greece study analyzed the currently available treatment options and the overall severity of plaque psoriasis.¹ It was found that a considerable proportion had not achieved the desired response of clear or almost clear skin with one-fifth of the population experiencing at least a moderate impairment in their quality of life. In Greece, the age-standardized prevalence rate of psoriasis is 1.96%, as of 2019.²

The epidemiological, multicenter, cross-sectional, retrospective chart review study recruited patients from April 7, 2020, to November 30, 2020. All participants (n = 280) received care in 11 centers across 4 geographic regions in Greece. All were between the ages of 18 and 75 with a median age of 29.9 years.

Patients were clinically diagnosed with mild (38.5%), moderate (35.2%), or severe (26.3%) psoriasis and had been on any approved systemic therapies for at least 24 weeks. Investigators used the Psoriasis Area and Index (PASI), Dermatology Life Quality Index (DLQI), EuroQol-5-Dimensions 5-Levels (EQ-5D-5L), and Work Productivity and Activity Impairment Questionnaire: Psoriasis (WPAI: PSO) to observe clinical characteristics and treatment regimens.

At the study visit, most patients were on biologic monotherapy while 16% were receiving non-biologic monotherapy and 6% had a combination therapy with both. TNF inhibitors were the most common biologic agents while the PDE4 inhibitor, apremilast was the most frequent non-biologic.

After a median treatment length of 30 months, the median PASI score was reduced from 14.7 to 1.8. Absolute PASI was ≤1 in 36.8% of patients, with 40% of those being in the biologic subgroup and 20% being in the non-biologic cohort. For those utilizing combination therapy, 37.5% of patients reached that same level. Even with these score reductions, a considerable portion of participants still had substantial residual skin disease with a PASI score >5.

“Based on multivariable logistic regression analysis, the odds of having a PASI score of ≤1 or ≤3 at the study visit were lower among patients with higher absolute PASI score and those with severe disease at the start of current treatment, and higher among patients currently receiving systemic treatment with biologics, as well as those with longer duration of current systemic treatment,” the authors explained. “Moreover, the odds of having a PASI score of ≤1 at the study visit were higher among patients who had received biologic agent(s) before the start of current treatment than those who had not.”

At the study visit, the median DLQI total score was 2.0 and over 50% of patients had a DLQI score ≥2. Patients in the non-biologic subgroup had a worse dermatology QoL when compared to those in the biologic group (26.7% vs. 16.0%, respectively). Overall, there was a low positive correlation between the DLQI total score and the absolute PASI score at the study visit. Further breakdown of QoL among the entire sample is as follows:

• 58.6% reported anxiety and/or depression
• 28.6% reported pain and/or discomfort
• 18.2% reported issues with mobility
• 11.4% reported issues with their usual activities
• 3.6% reported issues with self-care

Regarding patient satisfaction at the study visit, 96.4% of participants were satisfied with their current systemic treatment. More specifically, 45% were completely satisfied with 49.3% being in the biologic group, 17.8% being in the non-biologic group, and 62.5% being in the combination therapy group.

Even with the wealth of available psoriasis treatments, complete skin clearance, better QoL, and higher patient satisfaction are lacking in Greece. According to the researchers, newer therapies and a more patient-centric approach may improve this.

References

1. Rigopoulos D, Katsantonis J, Neofotistou O, et al. Psoriasis severity in moderate to severe psoriatic Greek patients routinely treated with systemic treatment: a cross-sectional and retrospective chart review study (CRYSTAL-Greece). J Dermatolog Treat. 2025;36(1):2402344. doi:10.1080/09546634.2024.2402344

2. Damiani G, Bragazzi NL, KarimkhaniAksut C, et al. The Global, Regional, and National Burden of Psoriasis: Results and Insights From the Global Burden of Disease 2019 Study. Front Med (Lausanne). 2021;8:743180. Published 2021 Dec 16. doi:10.3389/fmed.2021.743180