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The CDISC Intellectual Property Policy can be found on the CDISC website at: https://www.cdisc.org/about/bylaws.

Info
titleReviewers input requested

CDISC would appreciate supplement reviewers' input on their experience in using the PASI FEDLMAN instrument regarding what responses are being used for symptoms "erythema/redness", "thickness/induration" and "desquamation/scaling". There are 3 possible references that were found to explain PASI:

  • Feldman SR, Krueger GG. Psoriasis assessment tools in clinical trials. Ann Rheum Dis. 2005;64(Suppl 2):ii65–ii68.
    • Responses for symptoms are: none, slight, mild, moderate, severe.
  • Fredriksson T, Pettersson U. Severe psoriasis--oral therapy with a new retinoid. Dermatologica. 1978;157(4):238-44. doi: 10.1159/000250839. PMID: 357213.
    • Responses for symptoms are: none, slight, moderate, striking, exceptionally striking.
  • EMA guideline on Clinical Investigation of Medicinal Products Indicated for the Treatment of Psoriasis (https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-clinical-investigation-medicinal-products-indicated-treatment-psoriasis_en.pdf)
    • Responses for symptoms are based on Fredriksson (no symptoms, slight, moderate, marked, very marked) and are grouped as: mild to moderate, moderate, moderate to severe, and severe. 

CDISC would appreciate reviewer help regarding which list of responses are used (those that mirror Feldman, Fredriksson, EMA, or some other combination).

If the responses list is not in a majority (per public comment), it will be considered “undetermined.” The supplement will allow a sponsor’s list of responses, as was done in the CDISC PGI and CGI supplements.

1.1 Representations and Warranties, Limitations of Liability, and Disclaimers

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Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent version should be accessed through the CDISC website at: https://www.cdisc.org/standards/terminology/controlled-terminology.

Reference for the PASI V2FELDMAN:

Feldman SR, Krueger GG. Psoriasis assessment tools in clinical trials. Ann Rheum Dis. 2005;64(Suppl 2):ii65–ii68.

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All assumptions and business rules described in the SDTMIG RS domain are applicable to this supplement. Additional assumptions specific to the PASI V2 are FELDMAN are listed below.

The PASI V2 is a tool used to assess the severity of psoriasis. The PASI V2 FELDMAN is a tool used to assess the severity of psoriasis. However, there is no standard set of responses for the PASI that is used throughout the industry. This supplement uses the Feldman article as the standard for responses. The PASI FELDMAN divides the body into 4 sections (i.e.,  headhead, trunk, upper extremities, lower extremities) and assesses symptom severity and the percentage of each area affected by psoriasis. The symptoms are rated on a 5-point scale and the area is rated on a 7-point scale. Subscores for each section of the body and a total score are also captured.

  1. The scale points for the symptoms include a numeric rating (0-4) and a definition of what is represented by the rating (e.g., 0 = "None"). For the PASI V2FELDMAN, RSORRES is populated with the text description; the numeric rating is represented in the standardized character and numeric result variables RSSTRESC and RSSTRESN.

    1. CDISC created a CRF based on the Feldman article using the symptom terms "erythema/redness", "thickness/induration", and "desquamation/scaling". Per subject-matter expert recommendations, desquamation was included with scaling even though desquamation is not referenced in the Feldman article.
  2. The scale points for the area include a numeric rating (0-6) and a definition of what is represented by the rating (e.g., 0 = "0 (clear)"). For the area, RSORRES is populated with the text description; the numeric rating is represented in the standardized character and numeric result variables RSSTRESC and RSSTRESN.
  3. The PASI V2 instrument FELDMAN instrument includes subscores and a total score that are considered as captured data on the CRF and are not considered as derived in the example below. These scores may be submitted in SDTM or derived in the Analysis Data Model (ADaM) per scoring instructions from the Feldman reference.

    1. If operationally defined by the sponsor, it is the sponsor's responsibility to set the --DRVFL flag based on their eCRF process to derive subtotals and total scores. An investigator-derived score will be considered a captured score and not flagged. When subtotal and total scores are derived by the sponsor, the derived flag (--DRVFL) is set to "Y". However, when the subtotal and total scores are received from a central provider or vendor, the value would go into --ORRES and --DRVFL would be null (see SDTMIG Section 4.1.8.1, Origin Metadata for Variables).

    2. If scores are received by the sponsor, it is recommended that they are submitted to SDTM and verified in ADaM.

  4. Records are created in rs.xpt for every item on the instrument

    1. For items with no data, RSORRES, RSSTRESC, and RSSTRESN are all missing and RSSTAT = "NOT DONE".  If the reason is known, that reason is represented in RSREASND (e.g., RSREASND = "REFUSED"). If the reason is unknown, RSSTAT = "NOT DONE" and RSREASND is missing.

  5. Terminology

    1. RSCAT, RSTESTCD, and RSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the result field is provided in Section 4, SDTM Mapping Strategy.

3.2 Example for the PASI

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FELDMAN RS Domain Model

The PASI V2 FELDMAN example below shows the terminology used to implement the instrument in the RS domain. This example shows the data for 1 subject collected at the baseline visit for the PASI V2 instrument. The example uses CDISC Controlled Terminology for RSTESTCD, RSTEST, and RSCAT. All original results, matching the CRF item response text, are represented in RSORRES. This result is then represented as a standard numeric score in RSSTRESN and as a standard character representation in RSSTRESC.

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The table represents the items from the PASI V2 instrumentFELDMAN instrument.

Dataset wrap
Namers
Rowcaps
Rows 1-16:Show the symptom and area responses for the baseline visit.
Rows 17-29:Show the subscores and total scores for the baseline visit.
Rows 30-59:Show the subject was not evaluated on this instrument at visit 2. Since the reason for not completing the visit was collected, the date is included in RSDTC for when the visit was planned.
Dataset2
RowSTUDYIDDOMAINUSUBJIDRSSEQRSTESTCDRSTESTRSCATRSORRESRSSTRESCRSSTRESNRSSTATRSREASNDRSLOBXFLVISITNUMRSDTC
1STUDYXRS2324-P00011PASI0201PASI02-Head: Erythema/Redness
PASI V2FELDMANSlight11

Y12015-05-15
2STUDYXRS2324-P00012PASI0202PASI02-Head: Thickness/Induration
PASI V2FELDMANNone00

Y12015-05-15
3STUDYXRS2324-P00013PASI0203PASI02-Head: Desquamation/Scaling
PASI V2FELDMANNone00

Y12015-05-15
4STUDYXRS2324-P00014PASI0204PASI02-Head: Area Score
PASI V2FELDMAN<10%11

Y12015-05-15
5STUDYXRS2324-P00015PASI0205PASI02-Up Extrem: Erythema/Redness
PASI V2FELDMANMild22

Y12015-05-15
6STUDYXRS2324-P00016PASI0206PASI02-Up Extrem: Thickness/Induration
PASI V2FELDMANSlight11

Y12015-05-15
7STUDYXRS2324-P00017PASI0207PASI02-Up Extrem: Desquamation/Scaling
PASI V2FELDMANMild22

Y12015-05-15
8STUDYXRS2324-P00018PASI0208PASI02-Up Extrem: Area Score
PASI V2FELDMAN30 - <50%33

Y12015-05-15
9STUDYXRS2324-P00019PASI0209PASI02-Trunk: Erythema/Redness
PASI V2FELDMANNone00

Y12015-05-15
10STUDYXRS2324-P000110PASI0210PASI02-Trunk: Thickness/Induration
PASI V2FELDMANNone00

Y12015-05-15
11STUDYXRS2324-P000111PASI0211PASI02-Trunk: Desquamation/Scaling
PASI V2FELDMANNone00

Y12015-05-15
12STUDYXRS2324-P000112PASI0212PASI02-Trunk: Area Score
PASI V2FELDMAN0 (clear)00

Y12015-05-15
13STUDYXRS2324-P000113PASI0213PASI02-Low Extrem: Erythema/Redness
PASI V2FELDMANSlight11

Y12015-05-15
14STUDYXRS2324-P000114PASI0214PASI02-Low Extrem: Thickness/Induration
PASI V2FELDMANSlight11

Y12015-05-15
15STUDYXRS2324-P000115PASI0215PASI02-Low Extrem: Desquamation/Scaling
PASI V2FELDMANSlight11

Y12015-05-15
16STUDYXRS2324-P000116PASI0216PASI02-Low Extrem: Area Score
PASI V2FELDMAN10 - <30%22

Y12015-05-15
17STUDYXRS2324-P000117PASI0217PASI02-Head: Sum of Symptom Scores
PASI V2FELDMAN111

Y12015-05-15
18STUDYXRS2324-P000118PASI0218PASI02-Head: Sum X Area
PASI V2FELDMAN111

Y12015-05-15
19STUDYXRS2324-P000119PASI0219PASI02-Head: Sum X Area X 0.1
PASI V2FELDMAN0.10.10.1

Y12015-05-15
20STUDYXRS2324-P000120PASI0220PASI02-Up Extrem: Sum of Symptom Scores
PASI V2FELDMAN555

Y12015-05-15
21STUDYXRS2324-P000121PASI0221PASI02-Up Extrem: Sum X Area
PASI V2FELDMAN151515

Y12015-05-15
22STUDYXRS2324-P000122PASI0222PASI02-Up Extrem: Sum X Area X 0.2
PASI V2FELDMAN333

Y12015-05-15
23STUDYXRS2324-P000123PASI0223PASI02-Trunk: Sum of Symptom Scores
PASI V2FELDMAN000

Y12015-05-15
24STUDYXRS2324-P000124PASI0224PASI02-Trunk: Sum X Area
PASI V2FELDMAN000

Y12015-05-15
25STUDYXRS2324-P000125PASI0225PASI02-Trunk: Sum X Area X 0.3
PASI V2FELDMAN000

Y12015-05-15
26STUDYXRS2324-P000126PASI0226PASI02-Low Extrem: Sum of Symptom Scores
PASI V2FELDMAN333

Y12015-05-15
27STUDYXRS2324-P000127PASI0227PASI02-Low Extrem: Sum X Area
PASI V2FELDMAN666

Y12015-05-15
28STUDYXRS2324-P000128PASI0228PASI02-Low Extrem: Sum X Area X 0.4
PASI V2FELDMAN2.42.42.4

Y12015-05-15
29STUDYXRS2324-P000129PASI0229PASI02-Total Sum
PASI V2FELDMAN5.55.55.5

Y12015-05-15
30STUDYXRS2324-P000130PASI0201PASI02-Head: Erythema/Redness
PASI V2FELDMAN


NOT DONEREFUSED
22015-06-14
31STUDYXRS2324-P000131PASI0202PASI02-Head: Thickness/Induration
PASI V2FELDMAN


NOT DONEREFUSED
22015-06-14
32STUDYXRS2324-P000132PASI0203PASI02-Head: Desquamation/Scaling
PASI V2FELDMAN


NOT DONEREFUSED
22015-06-14
...














59STUDYXRS2324-P000159PASI0229PASI02-Total Sum
PASI V2FELDMAN


NOT DONEREFUSED
22015-06-14

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