Dermatology Life Quality Index in Patients with Psoriasis Treated with Biologic Versus Non-biologic Treatment in Malaysia: A Retrospective Cross-Sectional Study

TELEPROM Psoriasis: Enhancing patient-centered care and health-related quality of life (HRQoL) in moderate-to-severe plaque psoriasis

Background and purpose

Psoriasis is a chronic, immune-mediated inflammatory skin disease that significantly impacts patients' quality of life. The integration of telepharmacy has the potential to enhance patient care by providing flexible and personalized pharmaceutical follow-up. This study (TELEPROM Psoriasis) evaluates a telepharmacy model for evaluating electronic Patient-Reported outcomes (ePROMs) for individuals with moderate to severe plaque psoriasis in Spain with biological treatment.

Experimental approach

This multicenter prospective quasi-experimental study included 258 adult patients initiating or switching biological/immunomodulatory therapy for moderate to severe plaque psoriasis. Patients were recruited from public hospitals in Spain and monitored through the NAVETA telepharmacy platform over a six-month period. PROMs assessed were the Psoriasis Symptoms and Signs Diary and the Dermatology Life Quality Index at baseline, 1 month, 3 months, and 6 months. Data were analyzed using ANOVA, Student's t-test, multiple regression, and machine learning algorithms to evaluate ePROMs evolution and response and satisfaction with Telepharmacy follow up.

Key results

The analysis revealed significant influences of gender, employment status, educational level, and daily activity, but no effect of age, on responses to Patient-Reported Outcomes questionnaires. Machine learning models, particularly Random Forest (AUC = 0.98) and Support Vector Machine (AUC = 0.96), effectively predicted patient engagement. DLQI scores significantly decreased from 9.33 ± 7.75 at baseline to 4.34 ± 5.86 at 6 months. Similarly, the PSSD - 7 Days questionnaire showed major reductions, with scores dropping from 55.43 ± 29.94 to 30.73 ± 30.66 at 6 months, and 53% of patients reaching a score of 20 or less. Notably, women reported worse scores at all time points compared to men. Regression analysis explained only 13.2% of the variance in PROMs scores, identifying Employment Status and BMI Range as key contributors.

Conclusion

This study demonstrates the efficacy of biologic treatments in significantly improving HRQoL for psoriasis patients. Addressing demographic variables, such as gender, is key for optimizing treatment outcomes and improving ePROMs response rates. Tailored strategies and ML techniques can help identify low-engagement patients and mitigate disparities. Integrating sociodemographic factors into clinical decision-making and patient engagement strategies is fundamental for delivering equitable and comprehensive care.

Impact of residual skin lesions and previous biologic treatment failure on patient-reported outcomes in patients with psoriasis receiving biologic treatment

Recent advances in biologic treatments have made clear skin a realistic treatment goal for psoriasis. However, clear skin may not uniformly translate to an absence of impact on patients' quality of life. This retrospective observational study aimed to elucidate the factors influencing patient-reported outcomes in patients with psoriasis who have demonstrated successful clinician-reported outcomes on using biologics. A total of 96 patients who have achieved a ≥75% improvement in Psoriasis Area and Severity Index (PASI) scores with ≥6 months of biologic treatment were included. Their median PASI score was 0.4, with 37.5% having achieved PASI 100 (clear skin). Furthermore, 47.9% reported no impact of psoriasis on their quality of life (Dermatology Life Quality Index [DLQI] score 0 or 1), while 52.1% reported a negative impact (DLQI score ≥2). Notably, 28.1% of the participants had a history of biologic treatment failure, defined as the inability to achieve or sustain a 75% PASI improvement with the previously used biologic agent. Multivariable logistic regression analysis revealed a positive association between achieving PASI 100 and reporting no impact of psoriasis on quality of life (adjusted odds ratio [aOR] 3.88, 95% confidence interval [CI] 1.49-10.91, P = 0.007). Conversely, prior biologic treatment failure was negatively associated with reporting no impact of psoriasis on quality of life (aOR 0.13, 95% CI 0.02-0.65, P = 0.023). Furthermore, among patients with clear skin, those with experience of previous biologic treatment failure reported significantly lower quality of life than those without such experience (P = 0.033). In conclusion, minimal residual skin lesions and prior biologic treatment failure were associated with poorer patient-reported outcomes in patients with psoriasis. Opting for a biologic agent with the highest predicted efficacy, rather than pursuing a "step-up" approach with a higher possibility of treatment failure, may be a more suitable strategy in the biologic treatment of psoriasis.