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Many psoriasis patients dissatisfied with treatment

By Kathryn Doyle

NEW YORK (Reuters Health) - Half of people with psoriasis are not satisfied with the treatment they're receiving for the skin condition, according to a new study.

Marked by recurring patches of scaly, itchy skin, psoriasis affects about seven million adults in the U.S. and can be treated with topical creams, light therapy and oral medications.

Up to 20 percent of psoriasis patients eventually develop a form of arthritis related to the condition called psoriatic arthritis, according to the U.S. Centers for Disease Control and Prevention.

"Compared to other chronic conditions, patients with psoriasis and psoriatic arthritis may be at particularly increased risk of not receiving adequate treatment," lead author Dr. April Armstrong, a dermatologist at the University of California, Davis, said.

Although that's not always a problem for people with mild psoriasis, those with more severe forms of the condition have an increased risk of a range of other health problems, researchers said.

Between 2003 and 2011, more than 5,000 psoriasis or psoriatic arthritis patients in the U.S. filled out surveys about prescription medication use and treatment satisfaction for the National Psoriasis Foundation.

Depending on the year, between nine and 30 percent of the almost 1,900 people with severe psoriasis were not receiving treatment, with higher percentages for mild and moderate psoriasis.

Just over half of psoriasis patients and 45 percent of those with psoriatic arthritis reported being dissatisfied with their treatment, according to results published in JAMA Dermatology.

Most people who stopped taking newer injectable and intravenous drugs reportedly did so due to side effects or because the medication wasn't working.

Some also reported being unable to secure insurance coverage for so-called biologic medications, which include etanercept (marketed as Enbrel) and adalimumab (Humira).

Among patients who discontinued biologic medications in 2008, for example, 25 percent reported it had not worked, 17 percent reported a negative side effect and five percent said their insurance would not pay or they could not afford the medication.

The fact that so many patients stopped biologic medications, which are some of the newest and most effective options for severe psoriasis, indicates that better treatments are still needed, Dr. Will Taylor, a rehabilitation medicine specialist who researches psoriatic arthritis at the University of Otago in Wellington, New Zealand, said.

Taylor, who was not involved in the study, noted to Reuters Health that it only included members of the National Psoriasis Foundation, a small percentage of the total number of psoriasis patients in the U.S., which is a limitation.

For people with severe psoriasis, inadequate treatment can be serious because the condition is tied to physical and psychosocial problems, Armstrong said by email.

"Severe psoriasis is associated with increased risk of heart attack, stroke, and cardiovascular deaths," she said. "Many patients are ashamed of this skin disease and do not wish to go to a barber, a public swimming pool, or be involved in intimate relationships."

Psoriasis patients are also at increased risk of depression and suicide, Armstrong said.

She has received research grants or honoraria from pharmaceutical companies that make biologic drugs.

Many people may not have access to care or may not understand the severity of potential side effects of psoriasis, which could explain the undertreatment rates, Andrew Robertson, chief medical and scientific officer for the National Psoriasis Foundation in Portland, Oregon, said.

Dermatologists experienced with psoriasis aren't necessarily available to everyone in every area, and many insurance plans are hesitant to cover biologic medications, which may cost up to $25,000 yearly.

Some plans put psoriasis patients in a "specialty tier," which could require them to pay as much as 25 percent of the cost of the drug. That practice puts medications out of reach for some patients, Robertson told Reuters Health.

But for mild cases of psoriasis, forgoing treatment may not be a big deal, Taylor said.

The researchers agreed that psoriasis varies widely from patient to patient and treatment should be tailored to individual needs.

SOURCE: http://bit.ly/19NbI8P JAMA Dermatology, online August 14, 2013.

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