Treatment satisfaction of patients with psoriasis with topical therapy in a real-world setting: unmet need for higher effectiveness.

BACKGROUND: Topical medication is the mainstay for treatment of mild psoriasis. However, dissatisfaction with topicals is common and rates of non-adherence are high. Assessing patients' perspectives can help to identify unmet needs. OBJECTIVE: Our aim was to investigate satisfaction of patients with psoriasis with topical therapy and to determine influencing factors. METHODS: Patients were recruited from the Department of Dermatology, University Medical Center Mannheim, Germany. Satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication version 1.4 with the domains effectiveness, side effects, convenience, and global satisfaction (scale 0-100 each). The impact of sociodemographic and disease characteristics was determined by multivariate regression. RESULTS: Averaged across the cohort (n = 122, mean age 52.5 years, 58.2% male), the side effects domain had the highest mean satisfaction score (89.7), followed by convenience (72.5), global satisfaction (60.8), and effectiveness (55.0). Comparing specific medications, combinations of corticosteroids and vitamin D analogues were rated best in effectiveness. Treatment satisfaction was influenced by age, partnership, ability to apply topicals independently, disease-related quality-of-life impairment, sole or adjunctive use of topicals and pruritus. CONCLUSIONS: Participants were particularly satisfied with safety but rather dissatisfied with effectiveness of topicals. Topical therapy should be adapted to individual needs with special attention to effectiveness.

Patient preferences for topical psoriasis treatments: a discrete choice experiment.

BACKGROUND: Topical medication continues to be the most frequently prescribed therapy for psoriasis. However, patients are often dissatisfied with their topical medication, and adherence to this type of therapy is particularly poor. OBJECTIVE: To investigate the preferences of patients with psoriasis regarding the process and outcome attributes associated with topical treatments and to assess influencing factors. METHODS: A discrete choice experiment was conducted to analyze patient preferences for topical psoriasis treatments based on outcome attributes (probabilities of 90% improvement, 50% improvement, skin atrophy and skin irritation) and process attributes (treatment cost not covered by health insurance, treatment duration, location, frequency and formulation). RESULTS: The study cohort (N = 184) considered probabilities of 50% (Relative Importance Score (RIS)=41.0) and 90% (RIS = 33.9) improvement most important, followed by risk of skin atrophy (RIS = 26.4) and treatment cost (RIS = 22.2). Treatment location (RIS = 18.9), risk of skin irritation (RIS = 16.2), treatment frequency (RIS = 13.3) and formulation (RIS = 11.0) were considered less relevant. Income, cardiovascular disease, number of visits and current topical therapy influenced treatment preferences. CONCLUSIONS: Averaged across the cohort, participants preferred an efficient topical treatment associated with a low risk of skin atrophy and reasonable personal expenses. Individual preferences should be integrated into a shared decision-making process about psoriasis treatment.