Assessing Barriers and Educational Needs in Treatment of Moderate to Severe Psoriasis
Jovana Lubarda , PhD, Jelena Spyropoulos , PhD 1Medscape, LLC, New York, NY, USA
1
1
Results
Methods
•A 10-question online survey was
administered by an accredited CME
provider to assess management
approaches for moderate to severe
psoriasis, knowledge of emerging
therapies, and preference for future
CME opportunities.
•Physicians members of the website
participated without monetary
compensation or charge and only
those who treat at least 1 patient with
psoriasis each week were included in
the analysis.
•The survey was launched online on
October 15th, 2014 and data were
collected for 1 month.
Number of patients with moderate to severe
psoriasis treated by survey participants (n=50).
Figure 1:
50%
Figure 3:
22%
16%
20%
16%
6%
10%
0%
0%
0
1 to 3
4 to 6
7 to 9
10 to 12
13 or more
Frequency of Treatment Use
40%
30%
Survey participants’ rating of knowledge
about emerging therapies and their
mechanism of action in psoriasis using
a Likert scale (1 =no knowledge;
7=in depth knowledge) (n=50).
Figure 5:
In general, what is your treatment approach for
a patient who presents with moderate to severe
psoriasis (30% body surface area)? (n=50)
41%
60%
No
knowledge
49%
50%
40%
=1
29%
30%
16%
20%
2
0%
4%
10%
0%
Topical
corticosteroid
therapy
Number of Patients per Week
Oral
Anti-TNF agents
methotrexate
3
4
5
6
In depth
knowledge
=7
4% 14% 10% 37% 27%
Mean
Median
Std.
Dev.
4.9
5
1.3
8%
2%
Anti IL12/23 Other, please
therapy
specify (refer to
dermatologist)
Treatment for Moderate to Severe Psoriasis
Figure 2:
Survey participants’ cited issues or
concerns with emerging agents for
psoriasis treatment (n=50).
Figure 6:
Percentage of survey participants’ patients
currently treated with biologics (n=50).
Figure 4:
What percentage of your patients with psoriasis
do you currently treat with biologics? (n=50)
Survey participants’ cited barriers toward
improving patient care in psoriasis (n=50).
What issues or concerns do you have about
emerging agents for psoriasis treatment?
[Select all that apply.]
What are the most important barriers to
improving patient care in psoriasis?
[Select all that apply.] (n=50)
50%
40%
80%
73%
67%
70%
20%
10%
15%
Early diagnosis
14%
0%
0-5%
1.
enter A, Korman NJ, et al; American Academy of Dermatology Work Group. Guidelines of care for the
M
management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis
and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol.
2011;65(1):137-174.
2.
orld Health Organization. Sixty-Seventh World Health Assembly. Agenda item 13.5. Psoriasis.
W
http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R9-en.pdf. Accessed June 10, 2015.
Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment
dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National
Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149:1180-1185
6-10%
11-20%
Treatment adherence/
tolerability
Over 20%
Percentage of Patients Treated With Biologics
28%
29%
Management of associated
comorbidities
Financial/cost considerations
14%
Disease progression due to
under-treatment
Percent of Response for
Issues/Concerns
30%
References
3.
Survey participants’ treatment preferences
for moderate to severe psoriasis (n=50).
How many patients with moderate to severe
psoriasis do you see per week? (n=50)
Percent Responses
Psoriasis is a common, chronic,
inflammatory, multisystem disease that
can significantly impair quality of life.1
It affects approximately 2% of US adults,
and this condition was recently classified
as a global health priority by the World
Health Organization.2 Approximately 20%
of patients experience moderate to severe
disease, which constitutes having up to
10% of their body surface area covered
and includes involvement of the hands,
feet, facial, or genital regions, which may
interfere significantly with activities of
daily life.1 However, in a recent survey that
included more than 5600 patients with
psoriasis, more than half were dissatisfied
with their treatment; this continues to
remain a challenge, despite the availability
of newer treatment options.3 In addition,
many patients often discontinue therapy due
to loss of efficacy or adverse effects, and
the recurring nature of this disorder along
with the current quality of care may lead to
significant psychological distress. The goals
of this study were to determine physicians’
current barriers in the management of
moderate to severe psoriasis and to identify
areas of continuing medical education
(CME) need.
•A total of 50 physicians completed the survey.
•41% reported treating 4 to 6 cases of
moderate to severe psoriasis per week and
38% reported treating 7 or more cases per
week (Figure 1).
•Half of the physicians reported prescribing
biologics for only 20% of their patients with
moderate to severe psoriasis, and their
preferences for treatment in these cases were
as follows: 49% anti-tumor necrosis factor
(anti-TNF) agents, 29% oral methotrexate, 16%
topical corticosteroid therapy, and 4% antiIL12/23 (Figures 2 and 3).
•The cited barriers to improving patient
care were, in order of importance, 29%
financial, 28% adherence/tolerability, 15%
undertreatment, and 14% each for early
diagnosis and management of comorbidities
(Figure 4).
•When participants were asked to rate their
knowledge of emerging psoriasis therapies
and mechanisms using a Likert scale (1=no
knowledge; 7=in-depth knowledge), only 8%
reported having in-depth knowledge (mean ±
SD was 4.9 [± 1.3]) (Figure 5).
•Concerns about emerging therapies included
cost (73%), safety (67%), lack of knowledge of
available data (43%), lack of real-world data
(25%), and efficacy (20%) (Figure 6).
•Approximately one-third of the participants
reported using an online source to answer at
least 6 psoriasis-related patient inquiries per
month.
•Future CME needs, in order of highest
importance, were individualizing first-line
therapies, managing comorbidities, strategies
for overcoming nonadherence, second-line
therapy selection, and therapy mechanisms in
the context of psoriasis pathophysiology.
Percentage of Physicians Treating
With Biologics
Background
60%
50%
43%
40%
30%
25%
20%
20%
10%
4%
0%
Lack of knowledge Lack of real world
of efficacy/safety
data on new
data
agents
Cost of agents
Efficacy concerns
Safety concerns
I do not have
any issues about
new agents
Issues/Concerns for Emerging Agents in Psoriasis Treatment
Conclusions
Acknowledgements
Outside of cost, undertreatment with biologics and managing adherence were the key
issues reported among physicians treating patients with moderate to severe psoriasis.
Physicians would benefit from foundational and case-based CME -- which could be
delivered online -- on therapy selection and personalization, clinical data on current
and emerging biologics, and comprehensive management of psoriasis including
comorbidities.
The educational activity was developed by Medscape Education.
For more information, contact Jovana Lubarda, PhD, Associate Director,
Educational Strategy, Medscape, LLC, jlubarda@medscape.net.