Survey: Psoriasis/Psoriatic Arthritis Undertreated

ORLANDO – Patients with psoriasis and psoriatic arthritis have a high level of dissatisfaction with current treatment options and have numerous unmet health care needs, according to the U.S. findings from the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey.

Of 1,005 U.S. adults who participated in the population-based telephone survey, 735 had psoriasis diagnosed by a health care provider, and 270 had psoriatic arthritis diagnosed – with or without a diagnosis of psoriasis. Half of those surveyed reported dissatisfaction with available oral and biologic therapies, Dr. Mark Lebwohl of Mount Sinai Hospital, New York, and his colleagues reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Most respondents with psoriasis reported moderate symptoms (40%), with about 30% each reporting mild or severe symptoms. Itching was the most bothersome symptom, occurring in about 42% of patients, followed by flaking (26%) and scales (22%). Itching was the greatest contributor to estimates of disease severity.

Psoriatic arthritis patients were more likely to report severe symptoms (56%), while 12% reported mild symptoms, and about a third reported moderate symptoms. Itching was the most bothersome symptom among these patients, followed by pain (21%) and flaking (19%). Pain and joint swelling were the greatest contributors to estimates of disease severity in this group, the investigators said.

The majority of respondents (57%) had seen a doctor in the past year. For psoriasis patients, that doctor was most often a dermatologist (57%), while psoriatic arthritis patients most often saw a rheumatologist (38%).

A third of patients most often saw a primary care physician.

The main reasons cited for not having seen a doctor in the past year were having mild or no symptoms, and a feeling that a health care provider would be unable to help.

Of concern, patterns reported by the patients indicated widespread undertreatment of psoriasis and psoriatic arthritis, they said.

More than one in five psoriasis patients (22%) reported no treatment at the time of the survey, and although most described their disease as moderate or severe, only 23% reported ever discussing the use of conventional oral or biologic therapies with their health care providers, and only 9% were currently receiving systemic therapy; most were using prescription topical therapy.

Psoriatic arthritis patients were much more likely than were psoriasis patients to have ever used a conventional oral or biologic therapy, but only 50% were receiving systemic therapy, while 26% reported use of biologic therapy and 24% reported use of an oral therapy.

Methotrexate was the conventional oral therapy used most often (68% of the time), followed by cyclosporine and acitretin (in 14% and 12% of patients, respectively), and etanercept was the biologic therapy used most often (56%) followed by adalimumab (used by 48%).

The most common reasons for discontinuing treatment were concerns about safety, issues with tolerability, and lack or loss of effectiveness. The greatest contributors to treatment burden among those using conventional oral therapies were side effects and the need for laboratory monitoring, and the greatest contributors among those using biologics were concerns about long-term safety, anxiety or fear, pain, and inconvenience associated with self injection.

More than half of all respondents with psoriatic arthritis (51%) agreed that using currently available therapies can be worse than the condition itself, and 88% said better therapies are needed.

These results underscore the need for improved screening, as many patients with joint symptoms had not been diagnosed with psoriatic arthritis. They also demonstrate a need for improved assessment of disease severity; pruritus – which was reported as the most bothersome symptom – “is not included in most assessment tools,” the investigators noted.

Further, the results highlight the need for a higher level of treatment in many patients, they said, explaining that survey responses indicated substantial undertreatment in numerous cases. Many patients were receiving no treatment or only topical treatment, and many who were experiencing symptoms were not currently seeking care from a health care provider.

The MAPP survey is the first large-scale, multinational, population-based survey of psoriasis and psoriatic arthritis patients. The survey included 3,426 patients and 781 physicians in North America and Europe. The U.S. findings, which indicate little systematic implementation of treatment algorithms as well as widespread undertreatment, are particularly important given that psoriasis affects 3.2% of adults in the United States, and that 30% of those patients have psoriatic arthritis, the researchers noted.

Most of these patients report that their condition affects their emotional well-being, their quality of life, and their daily activities, they noted.

“These findings deserve attention and action to improve the care and lives of patients with psoriasis and psoriatic arthritis,” they concluded.

The survey was sponsored by Celgene, which markets apremilast (Otezla). Dr. Lebwohl disclosed ties to numerous pharmaceutical companies, including several that market drugs for psoriasis and psoriatic arthritis.

ORLANDO – Patients with psoriasis and psoriatic arthritis have a high level of dissatisfaction with current treatment options and have numerous unmet health care needs, according to the U.S. findings from the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey.

Of 1,005 U.S. adults who participated in the population-based telephone survey, 735 had psoriasis diagnosed by a health care provider, and 270 had psoriatic arthritis diagnosed – with or without a diagnosis of psoriasis. Half of those surveyed reported dissatisfaction with available oral and biologic therapies, Dr. Mark Lebwohl of Mount Sinai Hospital, New York, and his colleagues reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Most respondents with psoriasis reported moderate symptoms (40%), with about 30% each reporting mild or severe symptoms. Itching was the most bothersome symptom, occurring in about 42% of patients, followed by flaking (26%) and scales (22%). Itching was the greatest contributor to estimates of disease severity.

Psoriatic arthritis patients were more likely to report severe symptoms (56%), while 12% reported mild symptoms, and about a third reported moderate symptoms. Itching was the most bothersome symptom among these patients, followed by pain (21%) and flaking (19%). Pain and joint swelling were the greatest contributors to estimates of disease severity in this group, the investigators said.

The majority of respondents (57%) had seen a doctor in the past year. For psoriasis patients, that doctor was most often a dermatologist (57%), while psoriatic arthritis patients most often saw a rheumatologist (38%).

A third of patients most often saw a primary care physician.

The main reasons cited for not having seen a doctor in the past year were having mild or no symptoms, and a feeling that a health care provider would be unable to help.

Of concern, patterns reported by the patients indicated widespread undertreatment of psoriasis and psoriatic arthritis, they said.

More than one in five psoriasis patients (22%) reported no treatment at the time of the survey, and although most described their disease as moderate or severe, only 23% reported ever discussing the use of conventional oral or biologic therapies with their health care providers, and only 9% were currently receiving systemic therapy; most were using prescription topical therapy.

Psoriatic arthritis patients were much more likely than were psoriasis patients to have ever used a conventional oral or biologic therapy, but only 50% were receiving systemic therapy, while 26% reported use of biologic therapy and 24% reported use of an oral therapy.

Methotrexate was the conventional oral therapy used most often (68% of the time), followed by cyclosporine and acitretin (in 14% and 12% of patients, respectively), and etanercept was the biologic therapy used most often (56%) followed by adalimumab (used by 48%).

The most common reasons for discontinuing treatment were concerns about safety, issues with tolerability, and lack or loss of effectiveness. The greatest contributors to treatment burden among those using conventional oral therapies were side effects and the need for laboratory monitoring, and the greatest contributors among those using biologics were concerns about long-term safety, anxiety or fear, pain, and inconvenience associated with self injection.

More than half of all respondents with psoriatic arthritis (51%) agreed that using currently available therapies can be worse than the condition itself, and 88% said better therapies are needed.

These results underscore the need for improved screening, as many patients with joint symptoms had not been diagnosed with psoriatic arthritis. They also demonstrate a need for improved assessment of disease severity; pruritus – which was reported as the most bothersome symptom – “is not included in most assessment tools,” the investigators noted.

Further, the results highlight the need for a higher level of treatment in many patients, they said, explaining that survey responses indicated substantial undertreatment in numerous cases. Many patients were receiving no treatment or only topical treatment, and many who were experiencing symptoms were not currently seeking care from a health care provider.

The MAPP survey is the first large-scale, multinational, population-based survey of psoriasis and psoriatic arthritis patients. The survey included 3,426 patients and 781 physicians in North America and Europe. The U.S. findings, which indicate little systematic implementation of treatment algorithms as well as widespread undertreatment, are particularly important given that psoriasis affects 3.2% of adults in the United States, and that 30% of those patients have psoriatic arthritis, the researchers noted.

Most of these patients report that their condition affects their emotional well-being, their quality of life, and their daily activities, they noted.

“These findings deserve attention and action to improve the care and lives of patients with psoriasis and psoriatic arthritis,” they concluded.

The survey was sponsored by Celgene, which markets apremilast (Otezla). Dr. Lebwohl disclosed ties to numerous pharmaceutical companies, including several that market drugs for psoriasis and psoriatic arthritis.

ORLANDO – Patients with psoriasis and psoriatic arthritis have a high level of dissatisfaction with current treatment options and have numerous unmet health care needs, according to the U.S. findings from the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey.

Of 1,005 U.S. adults who participated in the population-based telephone survey, 735 had psoriasis diagnosed by a health care provider, and 270 had psoriatic arthritis diagnosed – with or without a diagnosis of psoriasis. Half of those surveyed reported dissatisfaction with available oral and biologic therapies, Dr. Mark Lebwohl of Mount Sinai Hospital, New York, and his colleagues reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Most respondents with psoriasis reported moderate symptoms (40%), with about 30% each reporting mild or severe symptoms. Itching was the most bothersome symptom, occurring in about 42% of patients, followed by flaking (26%) and scales (22%). Itching was the greatest contributor to estimates of disease severity.

Psoriatic arthritis patients were more likely to report severe symptoms (56%), while 12% reported mild symptoms, and about a third reported moderate symptoms. Itching was the most bothersome symptom among these patients, followed by pain (21%) and flaking (19%). Pain and joint swelling were the greatest contributors to estimates of disease severity in this group, the investigators said.

The majority of respondents (57%) had seen a doctor in the past year. For psoriasis patients, that doctor was most often a dermatologist (57%), while psoriatic arthritis patients most often saw a rheumatologist (38%).

A third of patients most often saw a primary care physician.

The main reasons cited for not having seen a doctor in the past year were having mild or no symptoms, and a feeling that a health care provider would be unable to help.

Of concern, patterns reported by the patients indicated widespread undertreatment of psoriasis and psoriatic arthritis, they said.

More than one in five psoriasis patients (22%) reported no treatment at the time of the survey, and although most described their disease as moderate or severe, only 23% reported ever discussing the use of conventional oral or biologic therapies with their health care providers, and only 9% were currently receiving systemic therapy; most were using prescription topical therapy.

Psoriatic arthritis patients were much more likely than were psoriasis patients to have ever used a conventional oral or biologic therapy, but only 50% were receiving systemic therapy, while 26% reported use of biologic therapy and 24% reported use of an oral therapy.

Methotrexate was the conventional oral therapy used most often (68% of the time), followed by cyclosporine and acitretin (in 14% and 12% of patients, respectively), and etanercept was the biologic therapy used most often (56%) followed by adalimumab (used by 48%).

The most common reasons for discontinuing treatment were concerns about safety, issues with tolerability, and lack or loss of effectiveness. The greatest contributors to treatment burden among those using conventional oral therapies were side effects and the need for laboratory monitoring, and the greatest contributors among those using biologics were concerns about long-term safety, anxiety or fear, pain, and inconvenience associated with self injection.

More than half of all respondents with psoriatic arthritis (51%) agreed that using currently available therapies can be worse than the condition itself, and 88% said better therapies are needed.

These results underscore the need for improved screening, as many patients with joint symptoms had not been diagnosed with psoriatic arthritis. They also demonstrate a need for improved assessment of disease severity; pruritus – which was reported as the most bothersome symptom – “is not included in most assessment tools,” the investigators noted.

Further, the results highlight the need for a higher level of treatment in many patients, they said, explaining that survey responses indicated substantial undertreatment in numerous cases. Many patients were receiving no treatment or only topical treatment, and many who were experiencing symptoms were not currently seeking care from a health care provider.

The MAPP survey is the first large-scale, multinational, population-based survey of psoriasis and psoriatic arthritis patients. The survey included 3,426 patients and 781 physicians in North America and Europe. The U.S. findings, which indicate little systematic implementation of treatment algorithms as well as widespread undertreatment, are particularly important given that psoriasis affects 3.2% of adults in the United States, and that 30% of those patients have psoriatic arthritis, the researchers noted.

Most of these patients report that their condition affects their emotional well-being, their quality of life, and their daily activities, they noted.

“These findings deserve attention and action to improve the care and lives of patients with psoriasis and psoriatic arthritis,” they concluded.

The survey was sponsored by Celgene, which markets apremilast (Otezla). Dr. Lebwohl disclosed ties to numerous pharmaceutical companies, including several that market drugs for psoriasis and psoriatic arthritis.