A study of 2,646 Swedish psoriasis patients receiving systemic therapy for their condition, conducted at Umeå University, Sweden, and the Swedish Institute for Health Economics, has found that nearly one in five had an inadequate response.
“Our results suggest that the currently available treatments are not sufficiently treating patients with moderate-to-severe psoriasis. So in order to manage their disease, more patients need access to currently available biologic agents as well as other new and more efficacious treatments,” dermatologist Dr. Marcus Schmitt-Egenolf, researcher at the Department of Public Health and Clinical Medicine at Umeå University and corresponding author of the study, said in a press release.
Published online in the Journal of Dermatologic Treatment (Jan. 30, 2017), the study used data from PsoReg, a Swedish national database of all patients with psoriasis receiving systemic therapies. PsoReg data includes average Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and responses to the EQ-5D health outcome questionnaire. The authors analysed data on a subgroup of patients who had persisting moderate-to-severe psoriasis— defined as having a PASI score of 10 or more, and / or a DLQI score of 10 or more after more than 12 weeks of treatment.
The mean overall PASI, DLQI, and EQ-5D scores were 4.12 (standard deviation [SD] 4.57), 4.11 (SD 5.24), and 0.79 (SD 0.22). A total of 472 patients (18%) had persisting moderate-to-severe psoriasis.
Compared to the larger patient group, the subgroup of patients with persisting psoriasis were younger and had higher BMI. They were also more often suffering from psoriasis arthritis and were more often smokers (p<0.01). They also reported poorer overall quality-of-life, measured with the standard evaluation method EQ-5D questionnaire (0.63 (SD 0.29) vs. 0.82 (SD 0.19) for the larger group, p<0.01).
“That almost one in five patients had highly active disease activity, despite ongoing systemic treatment, is concerning,” said Dr. Schmitt-Egenolf.
Based on the results, the authors make several suggestions. These include a recommendation that biologic therapies should be considered for patients with moderate-to-severe psoriasis who are using conventional systemic treatments, and that patients with moderate-to-severe psoriasis already receiving treatment with biologics may need new treatment options. They also suggest that patients should also receive support related to the improvement of lifestyle factors.