Patients With Mild Psoriasis Experience Less Favorable Status at Diagnosis and First Line of Treatment

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A recent poster at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 conference presented a real-world analysis published in the Journal of the American Academy of Dermatology, which found patients with mild psoriasis experience worse disease status than patients with moderate psoriasis at the time of diagnosis to initiation of current treatment.

The study aimed to characterize the disease profile and treatment patterns among patients with mild and moderate psoriasis. While the current management of mild to moderate psoriasis often entails topicals, phototherapies, and conventional systemic agents, most advanced therapies that exists are meant for moderate to severe psoriasis. This leaves a significant gap for patients not responding to current standard of care for milder forms of the disease.

Data included in the study was collected from a cross-sectional survey of physicians and their adult patients with psoriasis in the United States between December 2021 to March 2022. The data included information pertaining to the consulting patient’s demographics, disease profile such as body surface area (BSA) percentage affected by psoriasis symptoms, symptoms suffered, areas of the body affected, and prescribed treatment received.

The analysis included a total of 389 patients, including 72 patients with mild disease at diagnosis, and 317 patients with moderate disease. Both groups of patients had a similar mean age and sex distribution. However, patients with moderate psoriasis had a higher mean [SD] body mass index (BMI) of 27 [4.0](P = .0022) and a higher rate of concomitant psoriatic arthritis (PsA) of 7.6 [2.4](P = .4416) than patients with mild psoriasis.

Additionally, both groups reported similar affected body areas, but patients with moderate psoriasis reported more areas being affected (3.4 [1.8]; P < .0001) compared with patients with mild psoriasis (1.9 [1.2]; P < .0001). Furthermore, patients with mild psoriasis had a smaller average number of symptoms present at diagnosis (2.8 [1.5]; P < .0001) compared with patients with moderate psoriasis (3.8 [1.7]; P < .0001).

Patients with moderate psoriasis also experienced a greater reduction in mean percentage of BSA affected after diagnosis than patients with mild psoriasis. These patients were also treated more aggressively at diagnosis with conventional agents and biologic therapies used more commonly as the initial treatment at diagnosis compared with patients with mild psoriasis (P = .0173 vs P = .4391, respectively). Meanwhile, most patients received topicals as the initial treatment at diagnosis in both mild (87.3%) and moderate (86%) groups. The factors associated with receiving advanced therapies as the first line of treatment after diagnosis included older age, higher BMI, higher BSA percentage affected, symptoms at diagnosis (bleeding, cracked skin, burning), and affected body areas (neck and palm of hands).

Overall, patients with mild and moderate psoriasis reported similar symptoms at the time of diagnosis, but mild patients had fewer affected body areas. However, patients with mild psoriasis were observed to have a mean BSA affected at diagnosis of 6.2%, which indicates having moderate skin coverage. Furthermore, a higher proportion of patients with mild psoriasis experienced a flare at the time if survey completion.

These findings suggest a less favorable disease status for patients with mild psoriasis at the time of diagnosis to initiation of current treatment, highlighting potential unmet needs in the treatment of mild psoriasis. Moreover, the researchers suggest the possible negative impact of delaying initiation of more affective treatment in patients with mild psoriasis.

Reference

Wu D, Teneralli R, Fitzgerald T, et al. Patient characteristics, disease profile and treatment patterns in mild and moderate psoriasis patients in real world practices (prospect study). Poster presented at: AMCP Nexus; October 16-19, 2023; Orlando FL. Poster U13.

[This article was originally published by our sister publication, American Journal of Managed Care]