How Well-Being in Psoriasis is Being Assessed Via WHO-5, With Ulrich Mrowietz, MD

In a new HCPLive interview, Ulrich Mrowietz, MD, professor of dermatology at the University Medical Center Schleswig-Holstein in Kiel, Germany, spoke on recently published findings resulting from the POSITIVE study, describing the rising importance of patient-reported outcomes (PROs) in the psoriasis research landscape and within the broader movement toward patient-centered care.^1,2

The POSITIVE study, also previously highlighted at the 34th Congress of the European Academy of Dermatology and Venereology 2025 (EADV) in Paris, was noted by Mrowietz as having been designed as 1 of the first real-world psoriasis studies to implement the World Health Organization-Five Well-Being Index (WHO-5) as its primary endpoint rather than traditional physician-assessed disease measures.²

Why WHO-5 is Significant as a Tool for Psoriasis

“POSITIVE…was planned as such to be the first [trial] in the real world evidence-based space where the primary endpoint was not a somatic score, like in psoriasis with PASI or the Physician's Global Assessment, but a patient-reported outcome tool,” Mrowietz said.

Despite his acknowledgement of clinical metrics such as the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) as important, Mrowietz described WHO-5 as capturing a broader concept of well-being among patients given its encompassing of social, psychological, and personal health elements. Given the instrument’s established normative data among general populations across multiple countries, the POSITIVE team were able to compare the well-being of patients with psoriasis directly with that of the general European population.

Major Findings on POSITIVE Trial

Mrowietz described one of the study's most striking findings was the degree of improvement observed following treatment with tildrakizumab. Baseline WHO-5 scores were substantially lower than expected, reaching levels comparable to those reported in patients living with other serious chronic illnesses.

By the 16-week mark, however, average well-being scores had risen to levels comparable to those of those in the general European population and continued to see improvement throughout the 2-year study period. These gains paralleled sustained levels of skin clearance, with the majority of those evaluated showing low absolute PASI scores. Such scores were indicative of minimal disease activity.

Outside of patient well-being assessments, the POSITIVE study also examined the effects of psoriasis on family members through the FamilyPsO questionnaire. In his interview, Mrowietz stated that although partner burden improved over the course of the trial, concerns related to disease recurrence often persisted despite long-term disease control. What this essentially suggests, Mrowietz noted, is the psychological impact of chronic inflammatory disease may extend beyond the patient and continue after clinical symptoms have been addressed.

Disclosures: Mrowietz has reported serving as an advisor and/or received speakers’ honoraria and/or received grants and/or participated in clinical trials of AbbVie, Aditxt, Almirall, Amgen, Aristea, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Dr. Reddy’s, Eli Lilly, Foamix, Formycon, Immunic, Janssen, LEO Pharma, Medac, MetrioPharm, Novartis, Phi-Stone, Pierre Fabre, Sanofi-Aventis, UCB Pharma.

References

1. Mrowietz U, Sommer R, Augustin M, et al. Patient-Reported Well-Being in Value-Based Routine Care in Psoriatic Disease Using Tildrakizumab: 2-Year Data of the Phase IV POSITIVE Study. Psoriasis (Auckl). 2026 May 12;16:590189. doi: 10.2147/PTT.S590189. PMID: 42146323; PMCID: PMC13179756.

2. Almirall Presents Long‑Term Results from First Real‑World Dermatology Study Using WHO‑5 Well‑Being Index as Primary Endpoint in the treatment of Psoriasis at EADV 2025. Almirall, S.A. (ALM). https://www.almirall.com/news-media/newsroom/almirall-presents-long-term-results-first-real-world-dermatology-study-using.