Real-World Management, Treatment Patterns in Patients With Psoriasis, Psoriatic Arthritis

Posters presented at the 2023 Fall Clinical Dermatology conference aimed to identify patterns in management and treatment landscapes among individuals with psoriasis (PsO) and psoriatic arthritis (PsA), finding potential discrepancies and opportunities for updating diagnoses criteria.

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The first poster estimated the incidence of, time to, and factors associated with PsA diagnosis after incident PsO diagnosis. In the study, the researchers evaluated the disease management pattern by physician specialty 1-year before and after incident PsA diagnosis.¹

The data included in this study came from the HealthVerity Claims, Pharmacy, and Electronic Medical Record (EMR) databases between November 2015 and August 2022 among insured adults living in the United States. These patients had a 365-day baseline period with continuous medical coverage prior to the index date of an incident PsO diagnosis or incident PsA diagnosis.

A total of 15,337 patients were included in the PSO cohort, in which 639 (4.2%) were diagnosed with PsA during follow-up and had an overall incidence of PsA of 15.6 (95% CI, 14.4-16.8) per 1000 person-years and a median of 262 (IQR, 93-685) days to PsA diagnosis. Furthermore, the incident of and time to PsA diagnosis differed by physician specialty. However, inflammatory polyarthropathy, fibromyalgia, and uveitis had the strongest association with PsA diagnosis, regardless of physician specialty.

Similarly, PsA treatment and management patterns differed by managing-physician specialty in the PsO/PsA cohort. For instance, patients with Medicaid or living in Midwestern, Southern, or Western regions in the United States were more likely to be managed by a dermatologist compared with individuals with commercial insurance or living in Northeastern regions. Additionally, patients with joint pain or inflammatory polyarthropathy were more likely to be co-managed by dermatologists and rheumatologists than those without these conditions.

Furthermore, only 9.1% of dermatologist-managed patients visited a rheumatologist after a PsA diagnosis for any reason, and patients co-managed by dermatologists and rheumatologists were more likely to be prescribed csDMARDS than patients only managed by a dermatologist.

A second poster as part of the PROSPECT study aimed to describe and compare patient characteristics, disease profile, and treatment patterns among patients with mild and moderate psoriasis at the time of diagnosis, as well as identify factors associated with choices of the first-line prescribed treatment.²

The data included in this study was part of the Adelphi PsO Disease Specific Programme, a cross-sectional survey of physicians and their consulting adult patients with PsO living in France, Germany, Italy, Spain, and the United Kingdom between December 2021 and March 2022.

Patient information included demographics, disease profile such as body surface area percentage affected by PsO, symptoms suffered, areas of the body affected, and prescribed treatment received. Additionally, patients were grouped as mild or moderate, excluding patients with severe psoriasis.

A total of 875 patients were included in the analysis, with mild disease (n = 309) and moderate disease (n = 566) at diagnosis. Although both groups shared similar mean age and sex distributions, patients with moderate PsO had a higher rate of concomitant PsA (P = .0279). Furthermore, while patients in both groups reported similarities in most affected body areas, patients with moderate PsO reported more areas being affected with a mean (SD) of 4.4 (2.7) areas vs 2.9 (2.0) areas (P < .0001).

Therefore, these findings suggest discrepancies in recognizing more advanced disease and potential delays in more effective treatment for patients who may need more advanced treatment than topical therapy.

References

1. Gharib R, Benard M, Mohrova Z, et al. Management and treatment patterns in psoriasis and psoriatic arthritis. Poster presented at: 2023 Fall Clinical Dermatology conference. October 19-22, 2023. Las Vegas, NV.

2. Wu D, Teneralli R, Fitgerald 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: 2023 Fall Clinical Dermatology conference. October 19-22, 2023. Las Vegas, NV.