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. 2021 Dec;11(6):2057-2075.
doi: 10.1007/s13555-021-00620-x. Epub 2021 Oct 14.

Characterizing Outcomes and Unmet Needs Among Patients in the United States with Mild-to-Moderate Plaque Psoriasis Using Prescription Topicals

Shaloo Gupta  1 , Steven Garbarini  2 , Tara Nazareth  3 , Ibrahim Khilfeh  3 , Halley Costantino  2 , David Kaplan  4
Affiliations

Characterizing Outcomes and Unmet Needs Among Patients in the United States with Mild-to-Moderate Plaque Psoriasis Using Prescription Topicals

Shaloo Gupta et al. Dermatol Ther (Heidelb). 2021 Dec.

Abstract

Introduction: Topical therapies are considered first-line treatment in the management of plaque psoriasis (PSO). However, data on patient-reported outcomes for topicals are scarce. We designed a survey to record the treatment experience of patients with mild-to-moderate PSO using prescription topicals.

Methods: An online cross-sectional survey was conducted among adult patients on prescription topicals for mild-to-moderate PSO (body surface area [BSA] ≤ 10%) in the US. Data on treatment goals, changes in PSO after current treatment, satisfaction with current treatment (assessed with the Treatment Satisfaction Questionnaire for Medication [TSQM]), and treatment adherence (how often current treatment was taken as instructed) were collected. Descriptive analysis was used to evaluate outcomes.

Results: Of the 175 patients with mild-to-moderate PSO who completed the survey, 67.4% were female, with a median age of 55.0 years and 10.8 years since PSO diagnosis. Patients reported (medians) the use of three topicals since diagnosis, with 5 years on the current prescription topical. The top three treatment goals for current topical treatment were improvements in visible skin, 97.1%; non-skin related symptoms, 62.9%; and social/emotional well-being, 60.0%. Overall, 43.4% of patients reported 0% BSA change and 5.7% reported ≥ 75% BSA reduction. Approximately 75.0% each reported improvement in itch and pain symptoms. Embarrassment/self-consciousness because of skin symptoms persisted in 72.6% of patients. Median TSQM scores for global satisfaction, convenience, and effectiveness ranged between 58 and 72, indicating partial treatment satisfaction, except for side effects, which was high (median: 100). Approximately half of patients (49.7%) reported not being highly adherent to treatment.

Conclusion: Contrary to their treatment goals, patients with mild-to-moderate PSO using prescription topicals reported partial effectiveness, incomplete symptom resolution, impacted emotional and social well-being, and suboptimal global satisfaction, effectiveness, adherence, and convenience. Our findings highlight several unmet needs among topical-experienced, systemic-naïve patients with mild-to-moderate PSO using prescription topicals.

Keywords: Body surface area; Mild-to-moderate plaque psoriasis; Patient-reported outcomes; Prescription topicals; Treatment adherence; Treatment satisfaction.

Plain language summary

Psoriasis is a chronic skin disease caused by inflammation in the body. Raised areas, called plaques, are one of the main symptoms. These plaques may be red, flaky, itchy, and/or painful. Living with psoriasis can negatively impact a person’s well-being, especially when it affects visible areas such as the head, face, hands and nails, and/or sensitive areas like the genitals. Topical treatments, such as creams and lotions, are often the first therapy a doctor prescribes for psoriasis. Since these treatments are applied directly on the plaques, they can be messy and inconvenient. We conducted an online survey of adults with mild-to-moderate psoriasis, meaning that less than 10% of their body had plaques. We wanted to learn how they felt about their disease and their prescription topical treatments. Most people had psoriasis for about 10 years and had been using their current prescription topical for about 5 years. Approximately three of four people reported embarrassment/self-consciousness because of skin symptoms. Although three of four people reported some improvement in itch and pain, almost all people desired better resolution of plaques in visible areas. People also reported that: their current prescription topical did not completely resolve their symptoms, their emotional and social well-being was still suboptimal, they did not always apply their therapy as often as instructed, and they were not completely satisfied with their treatment overall. These results highlight the need for additional treatment options for people with mild-to-moderate psoriasis, particularly options that offer improved symptom control and are more convenient to use.

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Figures

Fig. 1
Fig. 1
Top three treatment goals indicated by patients with mild-to-moderate PSO and on current prescription topical. PSO plaque psoriasis. Visible skin symptoms refer to clearance of bothersome skin symptoms and body areas. Other non-skin symptoms refer to improved sleep or less itching, burning, or bodily pain. Social/emotional well-being refers to normal working/school/home life, better social interactions, improved self-esteem, and feeling happier. Decrease in treatment burden encompasses reduced lifestyle compromises and burden of treatment. Other consists of goals that do not apply to any of the previous categories
Fig. 2
Fig. 2
Patients with mild-to-moderate PSO and on current prescription topical experiencing symptoms by body area. PSO plaque psoriasis. Visible areas: face, neck, palms, back of hands, nails. Special areas: scalp, palms, genitals, anal area, areas on your body that flex, soles of feet, nails. Palmoplantar areas: palms, soles of feet. Intertriginous areas: genitals, anal area, areas on your body that flex
Fig. 3
Fig. 3
TSQM-11 outcomes. TSQM treatment satisfaction questionnaire for medication
Fig. 4
Fig. 4
Current treatment adherence in patients with mild-to-moderate PSO. PSO plaque psoriasis
Fig. 5
Fig. 5
Top ten reasons for non-adherence in patients with mild-to-moderate PSO. HCP healthcare provider, PSO plaque psoriasis
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