Psoriasis Patients Are Less Satisfied With Topical Therapy Efficacy

Credit: Unsplash / Patrick Tomasso

The efficacy of topical therapies may not be ideally satisfactory for patients with plaque psoriasis, according to new research.

In new findings from a Germany-based patient questionnaire analysis, a team of investigators observed that only 55% of patients using topical therapies to treat their psoriasis were satisfied with the treatment’s efficacy—a notable decrease from the rate of patients satisfied with its safety and convenience. The outcomes elucidate a growing need for efficacious and individualized topical therapy regimens to treat the common skin condition.

Led by Dr. Marthe-Lisa Schaarschmidt, of the department of dermatology, venereology and allergology at University Medical Center Mannheim, Heidelberg University, investigators sought to determine patient satisfaction with psoriasis topical therapies, and the predicating factors associated with each outcome. With up to 90% of all patients with psoriasis being inflicted with mild-to-moderate disease, lone topical therapy use is a common strategy to provide adequate control.

Options including combinations of topical corticosteroids, vitamin D analogues, antralin, topical calcineurin inhibitors, salicylic acid and moisturizers represent the robust drug class. But patient satisfaction with topical therapies remains a burden in psoriasis all the same.

“Despite these numerous options, overall satisfaction with topical therapy is limited,” Schaarschmidt and colleagues wrote. “Both primary adherence (redemption of the prescription) and secondary adherence (using the treatment correctly) are poor. The reasons given in the literature include frustration over low effectiveness, suboptimal cosmetic acceptability, high complexity of treatment regimes, and side effects.”

The team recruited patients with psoriasis at any level of severity from the inpatient and outpatient facilities at Mannheim’s department of dermatology from March 2015 – September 2017. Eligible patients had a physician-confirmed psoriasis diagnosis, were currently treating their condition with topical therapy as either a primary or combination regimen, and were ≥18 years old.

Patients were gauged on their current main topical therapy, other topical regimens, and other non-topical treatment modalities. Their satisfaction with treatment was assessed via the Treatment Satisfaction Questionnaire for Medication, a 14-item survey that gauges domains regarding effectiveness, adverse events, convenience and global satisfaction on a scale from 0 – 100.

The final analysis included 122 study participants; mean patient age was 52.5 years old and 58.2% were male. Mean scores for dermatology-related quality of life (DLQI) and Psoriasis Area Severity Index (PASI) were 11.6 and 5.8, respectively. Approximately one-fourth (28.8%) used topical therapy as a lone treatment, versus the 71.1% who used it as an adjunctive treatment. Another 34.8%, 33.1% and 24.6% of patients reported using phototherapy, biologicals and traditional systemic therapy, respectively.

The primary topical treatments used by surveyed patients included anthralin (22.1%), vitamin D analogues (20.5%), topical corticosteroids (19.7%) and fixed combination corticosteroids-vitamin D analogues (14.8%).

Mean scores for each of the surveyed domains regarding topical therapy satisfaction among patients with psoriasis were as follows:

• Adverse events: 89.7% (SD, 20.7)
• Convenience: 72.5% (SD, 23.9)
• Global satisfaction: 60.8% (SD, 22.5)
• Effectiveness: 55.0% (SD, 26.4)

Schaarschmidt and colleagues noted these data were in line with prior literature on the subject, though their research further showed variation on topical therapy effectiveness satisfaction based on the agent itself; while fixed-combination therapies were rated best in both efficacy and adverse event domains, topical salicylic acid scored the lowest on adverse events, and antralin in convenience.

“Taken together, satisfaction scores for specific medications show clear differences,” they wrote. “Patients’ individual satisfaction with regard to effectiveness, side effects and convenience should be evaluated during clinical visits in order to optimize the therapy if necessary.”

Patient clamoring for refined topical agents to treat psoriasis may not need to wait much longer. In a late 2022 interview with HCPLive, , Raj Chovatiya, MD, PhD, director of the Center for Eczema and Itch in the department of dermatology at Northwestern University Feinberg School of Medicine, said a “dozen or more therapies are on the way.”

“I think really, we’ve managed to push levels of clearance so high with biologic therapies, there’s those out there who say, ‘Well, we don’t really need more psoriasis therapies, do we?’” Chovatiya said. “But we know this is an incredibly common inflammatory disease, by no means do we have everybody under control—so we probably need to figure out every possible avenue we can get to this in order to get people matched up to the right therapy.”

Indeed, Schaarschmidt and colleagues concluded their research demonstrates the importance of “individualized topical treatment regimens as well as the need for novel effective topical agents.”

“Satisfaction with topical treatments should be evaluated regularly, and reasons for dissatisfaction should be exactly elucidated,” they wrote. “Adaptation of topical therapy to individual needs with special attention to effectiveness may increase satisfaction, which probably leads to improved adherence and, thereby, to higher treatment efficacy.”

References

1. ^{Ninosu N, Hoelker S, Kappenstein M, Buettner S, Peitsch WK, Schaarschmidt ML. Treatment satisfaction of patients with psoriasis with topical therapy in a real-world setting: unmet need for higher effectiveness [published online ahead of print, 2023 Apr 7]. J Dermatolog Treat. 2023;1-27. doi:10.1080/09546634.2023.2200570}
2. ^{Kunzmann K. The Emerging Oral & Topical Agents for Psoriasis. HCPLive. Published October 20, 2022. Accessed April 12, 2023. https://www.hcplive.com/view/emerging-oral-topical-agents-psoriasis}