Survey Finds Management of Psoriatic Disease in US Remains "Suboptimal"

There is an unmet need for better alignment between patients and physicians in the United States to optimize management of psoriasis (PsO) and psoriatic arthritis (PsA), new survey results suggest. Findings of the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey were published in the journal Dermatology and Therapy.

Data also showed that management of psoriatic disease remains suboptimal despite more treatment options available. Many patients reported moderate-to-severe disease and impaired quality of life (QOL), even with limited skin involvement, the authors wrote.

Researchers conducted the UPLIFT survey in 2020 in an effort to understand how disease perceptions have evolved for patients with psoriatic disease since the first Multinational Assessment of Psoriasis and Psoriatic Arthritis survey (MAPP) carried out in 2012. The current results reflect data from US respondents.

Survey participants included dermatologists, rheumatologists, and patients with a self-reported diagnosis of PsO and/or PsA. The multinational web-based survey was conducted between March 2, 2020 and June 3, 2020.

A total of 1006 US patients and 216 physicians completed the survey. It’s estimated PsO affects around 3% of US adults, or around 7.5 million people, while PsA affects around 30% of these patients. Of the patients included, 535 had PsO only, 72 had PsA, and 399 had PsO and PsA. One-hundred and fifteen dermatologists responded along with 101 rheumatologists.

The majority of patients (66.4%) reported a body surface area (BSA; assessed by number of palms) of 3 or less, and of these patients, 56.2% rated their disease as moderate or severe. Among patients with PsO, 40.1% felt they were somewhat aligned with their dermatologists regarding treatment goals, and 49.3% felt they were very closely aligned with their dermatologists.

Most patients with PsA, on the other hand, felt that they were not too closely or not at all aligned with their rheumatologists (32.1% and 59.3% of patients, respectively). Of the patients surveyed, most reported feeling a moderate (PsO, 35.5%; PsA, 31.8%) or strong (PsO, 47.7%; PsA, 53.9%) need for better treatments.

Most patients (60.8% to 86.1%) across BSA subgroups had a Dermatology Life Quality Index score of 6 or greater, indicating at least a moderately impacted QOL.

“Despite more treatments being available at the time of the UPLIFT survey versus the MAPP survey, UPLIFT responses demonstrate a continued unmet need for better disease management,” authors wrote. “In addition, differing perceptions among patients and physicians about treatment goals require additional research to understand how patients and physicians can collaboratively make management decisions to optimize overall care.”

Overall disease perceptions were similar between the global and US populations, although the US populations had a higher prevalence of overweight or obesity than the global cohort (58.6% vs 49.2%, respectively). US participants also had a higher proportion of all comorbidities apart from liver disease compared with the rest of the world.

While a greater proportion of US respondents had PsO and PsA, a slightly lower percentage of US patients reported a BSA of 3 or lower, the authors added. Reasons for treatment discontinuation were similar between the US and global cohorts with regard to oral and topical therapies.

Recall bias may have been present in the study, marking a limitation. In addition, participants were selected from an online panel, meaning they may not be fully representative of the general population. As the survey was conducted in part during the COVID-19 pandemic, this may have affected patients’ burden of disease, authors cautioned.

“Survey responses highlighted the need for treatment optimization as well as alignment between patients and [health care providers],” they concluded. “A large percentage of US patients had impaired QOL and a positive depression screen, suggesting a potential need for a mental health evaluation. In addition, most patients with PsO and joint pain may need a referral to a rheumatologist.”

Reference

Merola JF, Ogdie A, Gottlieb AB, et al. Patient and physician perceptions of psoriatic disease in the United States: results from the UPLIFT survey. Dermatol Ther. Published online May 15, 2023. doi:10.1007/s13555-023-00929-9