Adherence to adalimumab in patients with moderate to severe psoriasis.

Background The chronic and relapsing course of psoriasis is often associated with poor adherence to treatment. Adherence to topical treatment is abysmal. Adherence to systemic treatments also decreases over time, with an overall adherence rate of 67% for injectable biologic medications. Whereas overall trends in poor adherence have been documented, the fine details of adherence in individual patients is not well characterized. Purpose To assess adherence to adalimumab in patients with moderate to severe psoriasis. Methods Data on adherence were obtained from a 1-year open label trial including seven patients with moderate to severe psoriasis who agreed to participate in a randomized trial of standard physician education materials plus extended nurse education versus standard physician education materials alone. Adherence to treatment was recorded with electronic monitoring via Medication Event Monitoring System (MEMS) caps undisclosed to the patients. Patients were also instructed to note the time and date they used treatment in a journal. Results The subjects exhibited a broad range of adherence behaviors. Conclusions Adherence to adalimumab therapy for moderate-to-severe psoriasis is variable and can be very poor. The clinical impact of poor adherence to injectable biologic medications is not yet well characterized.

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis.

BACKGROUND: In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option. OBJECTIVE: We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis. METHODS: In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger. RESULTS: Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope -0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not. LIMITATIONS: Small sample size and lack of follow-up on some patients were limitations of this study. CONCLUSIONS: Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

Biologic therapy for psoriasis: telephone triage.

The past 15 years have been a time of remarkable achievement in the treatment of psoriasis. New topical medications with efficacy and safety have been introduced. At the same time, there has been resurgence in the use of traditional agents such as methotrexate and cyclosporine. An enlightened understanding of psoriasis as an immune-mediated disease has led to the development of unique injectable medications called biologics. All of these developments have occurred in part as we have gained a better understanding of the powerful impact that psoriasis has on patients. The biologics represent a new and exciting class of medications for treating psoriasis. Their novelty is reflected by both excitement and uncertainty. Efficacy rates of the biologics in treating psoriasis are unparalleled and safety data over the short term is promising. However, long-term safety data does not exist. Furthermore, as with any new class of medication, specifically an injectable preparation costing approximately $18,000 to $30,000 annually, concern on the part of patients is expected. Despite any uncertainty, the biologics are drastically altering the arena of psoriasis care. Clinicians have an entirely new class of medications to recommend to patients who have either failed or are not eligible for traditional agents. At the same time, due to the expense of these agents, the relationship between the patient, clinician, and insurer is changing. Certainly the introduction of biologics has created a need for educating clinic staff regarding these therapies. There are barriers to the effective and safe use of the biologics; often, these barriers lie at the level of the patient and depend on his comfort level and understanding of the treatment. This being said, it is the charge of the dermatology community, especially those on the front lines such as nurses, to lead efforts in patient education to ensure the best care for those suffering from psoriasis.