Improving systemic therapy selection for inflammatory skin diseases: A clinical need survey

Abstract

Background: Empirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased health care costs. However, routine molecular testing for AD and PSO are lacking.

Objective: To examine (1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and (2) to determine how often the current approach leads to patients switching medications.

Methods: A 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.

Results: Clinicians participating in the survey (265/414, 64% response rate) ranked "reported efficacy" as the most important factor governing treatment choice (P < .001). However, 62% (165/265) of clinicians estimated that 2 or more systemic medications were typically required to achieve efficacy. Over 90% (239/265) of respondents would or would likely find a molecular test to guide therapeutic selection useful.

Limitations: To facilitate ease of recall, questions focused on systemic therapies as a whole and not individual therapies.

Conclusion: Clinicians want a molecular test to help determine the most efficacious drug for individual patients.

Keywords: atopic dermatitis; biologics; gene expression profile test; inflammatory skin disease; molecular; precision medicine; psoriasis; response to therapy; systemic therapy.

Fig 1

Psoriasis. Factors clinicians consider when choosing an initial systemic therapy for patients with psoriasis (N = 265). Each therapy selection factor was rated on a 5-point Likert scale from most important (1) to least important (5) with compiled data shown as boxplots. The number of responses collected per attribute ranged from 255 to 262. The horizontal bar indicates the median value, box ends demarcate the first and third quartiles, whiskers show the range of observations within 1.5 times the interquartile range below the first quartile and above the third quartile, and circles represent outliers.

Fig 2

Psoriasis and atopic dermatitis. Factors clinicians consider when choosing a second line systemic therapy due to loss of efficacy from the first therapy in patients with atopic dermatitis or psoriasis (N = 265). Each therapy selection factor was graded on a 5-point Likert scale from most important (1) to least important (5) with compiled data shown as boxplots. The number of responses collected per attribute ranged from 262 to 265. The horizontal bar indicates the median value, box ends demarcate the first and third quartiles, whiskers show the range of observations within 1.5 times the interquartile range below the first quartile and above the third quartile, and circles represent outliers.

Fig 3

Psoriasis. Clinician estimates of the average number of systemic therapies for their patients with psoriasis to identify an efficacious drug (N = 265). Respondents were asked to identify the average number of systemic therapies attempted before finding one that is efficacious for their patients with psoriasis on systemic therapy. Selections for the average number of systemic therapies per patient were 1 (blue bar), 2 (black bar), or ≥3 (white bar).

Fig 4

Psoriasis and atopic dermatitis. Clinician interest levels in using a predictive biomarker test providing guidance on therapy selection for patients with atopic dermatitis or psoriasis (N = 265). Respondents were asked to rate how useful they would find a personalized molecular test informing on therapy selection for patients with moderate-to-severe atopic dermatitis or psoriasis. Responses were rated on a 5-point Likert scale from useful (“yes”), “likely” useful, “not likely” useful, “not sure”, to not useful (“no”).

Fig 5

Psoriasis and atopic dermatitis. Respondent selection of patient groups with psoriasis and atopic dermatitis with unmet therapeutic needs for whom clinicians would be interested in using a personalized molecular test to guide systemic therapy selection. A, Respondents (N = 265) were asked to select all applicable moderate-to-severe patient groups with atopic dermatitis or psoriasis for which the clinicians would prefer to use a molecular test to guide their systemic therapy selection. Difficult to treat disease regions included nail/scalp/genital involvement or body surface area >10%. B, The patient group selections from (A) were summed per respondent and presented as parts of a whole.