Psoriasis Trends and Practice Gaps

Perspectives of Japanese patients on psoriatic disease burden: Results from "Psoriasis and Beyond," the Global Psoriatic Disease Survey

Psoriatic disease (PsD) is a chronic disease affecting skin (psoriasis) and joints (psoriatic arthritis, PsA) that has a significant impact on patients' quality of life (QOL). We report findings from the Japanese subgroup of patients included in Psoriasis and Beyond: The Global Psoriatic Disease Survey, a cross-sectional, quantitative online survey of patients with self-reported, healthcare professional (HCP)-diagnosed, moderate-to-severe plaque psoriasis, with or without PsA. Eligible patients who were recruited online completed a 25-min internet-based survey in Japanese. We assessed patients' understanding of the systemic nature of PsD, disease burden, perception towards their HCPs, treatment expectations, and satisfaction with care. Of the 148 patients, 74% were females. In total, 65% of patients were aware of the systemic nature of their disease. A minority of patients (27%) were aware that PsA was related to their psoriasis, and 30% and 42% of patients were unaware of any manifestations and comorbidities, respectively, related to PsD. Overall, 21% of patients reported that their disease has a "very large" to "extremely large" impact on their QOL (assessed by Dermatology Life Quality Index score), while the majority (61%) reported a "small" effect or "no effect" at all on QOL. Patients experienced stigma and discrimination and had a negative impact on relationships due to PsD. More patients with psoriasis and concomitant PsA (66%) were satisfied with their current treatment than those with psoriasis alone (46%). Overall, 41% of patients were not involved in deciding their treatment goals. These results suggest that Japanese patients may not be fully aware of the systemic nature of PsD, its manifestations and comorbidities. While these patients were somewhat satisfied with their current treatment, they were only occasionally consulted in deciding treatment goals. Policy measures are required to address the stigma and discrimination experienced by patients. Increased patient participation in their care supports shared decision-making and enhanced treatment outcomes.

CITY-PSO: Prescribing behaviour of French private-practice dermatologists in psoriasis management: An observational, multicentre, cross-sectional study

BACKGROUND

Information regarding the prescribing behaviour of French private-practice dermatologists (PPDs) is scarce.

OBJECTIVES

First, to describe the population of PPDs involved in psoriasis management. Second, to describe the population of adult patients treated for psoriasis and their management.

METHODS

We published a call for participation targeting PPDs; we first asked respondents to complete a form regarding their prescribing behaviour, and then to include consecutive patients consulting for psoriasis during a one-month study period and to collect patient data.

RESULTS

The 94 participating PPDs included 1022 patients of mean age 52.9±17.9 years. The average body mass index was 28, and 25% had vascular comorbidities. Two thirds of patients had chronic psoriasis, for which 45% had consulted at least 5 times. Psoriasis was mostly with plaques (70.8%) and 11.4% of patients had psoriatic arthritis. The average body surface area (BSA) affected was 10.1%. Among the 679 patients without initial systemic treatment, 159 were started on systemic treatment. The main agents initiated were phototherapy (n=63), methotrexate (n=40), acitretin (n=30) and apremilast (n=20). In multivariate analysis, a higher BSA [Odds Ratio (OR) 1.10, 95% Confidence Interval (CI): 1.07-1.13; P<10^-4] and Dermatology Life Quality Index (DLQI) [OR 1.09, 95% CI: 1.03-1.15; P=0.04] were associated with prescription of systemic therapy at the end of the consultation.

CONCLUSION

The main limitation of our study was that participating PPDs were strongly involved in psoriasis management, which accounts for the high proportion of moderate-to-severe psoriasis and prescription of systemic treatments. Such committed PPDs and the development of psoriasis networks are key factors for improving the quality of care provided to psoriasis patients.

Increased biologic utilization in Latino patients with psoriasis

INTRODUCTION

Hispanic/Latino populations are more likely to have extensive psoriasis than the non-Hispanic/Latino population. Biologics are indicated for moderate/severe psoriasis or psoriasis with comorbidities. No studies have assessed ethnicity as a predictor of biologic utilization. We aimed to determine if biologic utilization differs between Latinos and non-Latinos with psoriasis.

METHODS

This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2003 to 2016. Psoriasis visits were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. The primary outcome is biologic use at the time of visit.

RESULTS

Of 1202 psoriasis visits, Latinos consisted of 9.7% (95% Confidence Interval 7.3-12) of the study population and 65% (95%CI 61-69) used private insurance. Multivariate analysis reveals the increased likelihood of biologic utilization in Latinos compared to non-Latinos (Odds Ratio (OR) 2.4, 95% CI 1.1-5.4, p = .03). Independently, private insurance status is associated with increased biologic use compared to public insurance (OR 2.4, 95% CI 1.2-5.0, p = .02). Private insurance status did not differ between Latinos and non-Latinos with psoriasis (OR 1.0, 95% CI 0.5-1.9, p = .98).

CONCLUSIONS

Hispanic/Latino ethnicity and private insurance status are independent predictors of biologic utilization, suggesting that biologic mechanisms may influence the increased use of biologics in Latinos with psoriasis.

Clinical Goals and Barriers to Effective Psoriasis Care

Engaging global key opinion leaders, the International Psoriasis Council (IPC) held a day-long roundtable discussion with the primary purpose to discuss the treatment goals of psoriasis patients and worldwide barriers to optimal care. Setting clear expectations might ultimately encourage undertreated psoriasis patients to seek care in an era in which great gains in therapeutic efficacy have been achieved. Here, we discuss the option for early treatment of all categories of psoriasis to alleviate disease impact while emphasizing the need for more focused attention for psoriasis patients with mild and moderate forms of this autoimmune disease. In addition, we encourage policy changes to keep pace with the innovative therapies and clinical science and highlight the demand for greater understanding of treatment barriers in resource-poor countries.