INTRODUCTION: Psoriasis is a chronic dermatologic condition that diminishes patients’ quality of life. Several treatments are available, each with specific efficacy, risks, and burden that influence patients’ treatment decisions. This study’s objectives were to identify factors associated with the choice of a new once-daily oral treatment with superior efficacy to existing orals, to elicit patient views on treatment attributes, and to rank attributes by importance among patients with moderate-to-severe psoriasis.
METHODS: This was a non-interventional, cross-sectional survey study among adult patients with moderate to severe psoriasis in the United States. Patients were assigned to predefined groups based on their treatment (apremilast, TNFi, ustekinumab, topicals) at the time of the survey. Respondents were shown a profile of a hypothetical once-daily oral treatment with superior efficacy to apremilast, then asked their views on its interference with everyday life, convenience, anxiety associated with it, its symptom reduction, and their likelihood of initiating it. Respondents ranked characteristics of psoriasis treatment in order of importance. Stepwise multivariable logistic regression identified patient factors associated with treatment choice.
RESULTS: The study included 882 patients (mean age, 45.7 [±12.8] years; female, 67.7%; White, 74.9%), 92.8% of whom were currently receiving treatment (mean duration = 2.9 [±4.8] years). Most (50.8%) patients reported their psoriasis as mild, very mild, or none; 36.5% as moderate; and 12.7% as severe or very severe over the past week. In patients (66.5%) indicating a willingness to start the once-daily oral treatment, 77.8% said it would cause less anxiety than an injection/infusion, 72.1% said the treatment would interfere less with their everyday life, 66.1% said it would reduce their symptoms more than their current psoriasis treatment, and 55.9% had moderate or severe psoriasis over the past week. Extent of skin clearance and route of administration were the most valued treatment attributes. Most apremilast users (55.2%) indicated a willingness to start the new oral treatment. Compared with apremilast users, patients were significantly more likely to start the new treatment if they currently received TNFi (74%, OR=2.1, 95% CI=1.4-3.1) or ustekinumab (75.5%, OR=2.7, 95% CI=1.6-5.0); if they reported mild (OR=3.2, 95% CI=2.0-4.9), moderate (OR=5.0, 95% CI=3.1-8.2), or severe (OR=7.6, 95% CI=3.9-15.0) psoriasis compared with those who reported no psoriasis symptoms in the past week; and if they were Black/African American (OR=2.4, 95% CI=1.4-4.2) versus White.
CONCLUSIONS: Most patients indicated willingness to start the new oral treatment, consistently viewing it as less anxiety-provoking than injections. Extent of skin clearance and route of administration were the top ranked treatment attributes.
