What Patients Need From Their Psoriasis Therapy

Psoriasis patients consider reduced scaling/flaking (64%), reduced itching (62%), and reduced redness and inflammation (52%) to be the top 3 most meaningful benefits when considering a new treatment, according to a patient poll during the US Food and Drug Administration (FDA) public meeting on patient-focused drug development for psoriasis. When asked to choose 1 benefit, 22% of patients indicated reduced scaling/flaking and reduced itching would be the most meaningful, with 18% of patients choosing reduction in the number of plaques, 16% reduced burning/stinging, and 11% reduced redness and inflammation.

The FDA held the meeting on March 17. According to Theresa Mullin, PhD, Director of the Office of Strategic Programs for the Center for Drug Evaluation and Research of the FDA, “Patient perspective helps inform [the FDA’s] understanding of the context for the assessment of benefit-risk and decision making for new drugs.” In addition to patient testimonials, the FDA posed a number of polls to learn about patient preferences. Their responses offer insight for dermatologists on the symptoms that are most bothersome to patients and the results patients want to see with treatment.

Of all the nonjoint symptoms of psoriasis, patients indicated that flaking/scaling (67%), itching (67%), dry cracked skin that may bleed (39%), pain or soreness (37%), and burning/stinging (25%) were the top 5 symptoms having the most significant impact on their daily life. The top 5 most bothersome impacts of psoriasis symptoms included emotional impacts (eg, self-esteem)(59%), limitations on activities (eg, work, school, sports, hobbies)(42%), stigma or embarrassment (41%), ability to fall asleep or stay asleep (39%), and impact on sexual intimacy (34%).

Of the drug therapies or medical devices used by patients to treat psoriasis, an overwhelming 96% of patients reported use of topical treatments, followed by oral or injected medications (76%), phototherapy (64%), and oral prescription medications (62%). Aside from drug therapies, patients indicated that they are managing their symptoms with over-the-counter products (eg, coal tar, salicylic acid, Epsom salt)(35%), complementary or alternative therapies (27%), other therapies not mentioned (18%), diet modifications (10%), no therapy (8%), or dietary and herbal supplements (2%).

The top ranking factors affecting the patients’ decisions about using treatments to help reduce or control the spread of psoriasis included whether the drug showed effectiveness for the specific benefit that is most meaningful for you (64%), access to treatment (eg, insurance coverage)(44%), and the possibility of rare but serious side effects (eg, blood disorders, certain cancers)(31%). The lowest ranking factor was how the medication is administered (4%).

In March 2015, Jeffrey M. Weinberg, MD, explored the topic of treatment refusal in his editorial, “First Refusal.” He reviewed the results from a study that sought to investigate refusal of topical treatments by patients living with psoriasis in France as well as the factors that influence such refusal (J Dermatolog Treat. 2015;2:1-5). “The findings of this study indicate possible strategies to reduce patient refusal,” Dr. Weinberg wrote. “For example, enhanced education about the therapeutic options for psoriasis and their benefits could counter negative perceptions about these therapies. It also appears that increased focus on the physician-patient relationship may have a positive impact in this area.” Focusing on the treatment of the patient’s most bothersome symptoms with therapies that will target these symptoms may help to strengthen the patient-physician relationship and ensure patient compliance to therapy.