Acceptability of 'as needed' biologic therapy in psoriasis: insights from a multistakeholder mixed-methods study.

BACKGROUND: Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. It is current practice to continue biologic therapy indefinitely in these patients, which contributes to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this; however, our understanding of patient and clinician perceptions of this strategy is limited. OBJECTIVES: The aim of this mixed-methods study was to gain insight into the perspectives of both patients and clinicians regarding the acceptability of an 'as needed' approach to biologic therapy in psoriasis, including potential barriers and enablers to implementation in routine care. METHODS: We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. RESULTS: Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43 of 64 patients) and 78% (21 of 27 clinicians) supported the use of 'as needed' biologic therapy, respectively. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis [9 female patients (60%), average disease duration 32 years (range 9-64)] and 9 dermatology clinicians [8 female clinicians (89%), average dermatology experience 20 years (range 8-33)]. Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt reaccess to medications upon psoriasis recurrence. CONCLUSIONS: These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost-effectiveness is warranted to enable the real-world potential of this approach to be realized.

Psoriasis is a common skin disease that affects up to 2% of adults in the UK and causes red, scaly patches of skin. A new group of injectable medicines (called biologics) are extremely effective at controlling psoriasis. However, continuous use of these medicines can increase the risk of negative side-effects (such as infections). 'As needed' biologic therapy is when a person takes their biologic medication at the first sign of psoriasis recurrence (rather than continuously). This approach has potential to reduce the risks associated with taking biologics, while still maintaining good control of psoriasis symptoms. 'As needed' therapy has not been used in psoriasis yet, and so we wanted to know what people with psoriasis and healthcare professionals thought about this approach. We carried out national surveys of people with psoriasis and healthcare professionals to explore their views on 'as needed' biologic therapy. We also held group interviews to understand in more detail the positive aspects and potential issues with this approach. Overall, we found that an 'as needed' approach was viewed as acceptable by people with psoriasis and healthcare professionals. They thought this approach would reduce the negative impacts of treatment and allow patients to have more ownership of their care. Potential issues included the possibility of patients' psoriasis returning, as well as ensuring that they had access to medication quickly enough when needed. These findings indicate that 'as needed' biologic therapy in psoriasis is acceptable from both a patient and clinician perspective.

Geroprotectors and Skeletal Health: Beyond the Headlines.

Osteoporosis and osteoarthritis are the most common age-related diseases of the musculoskeletal system. They are responsible for high level of healthcare use and are often associated with comorbidities. Mechanisms of ageing such as senescence, inflammation and autophagy are common drivers for both diseases and molecules targeting those mechanisms (geroprotectors) have potential to prevent both diseases and their co-morbidities. However, studies to test the efficacy of geroprotectors on bone and joints are scant. The limited studies available show promising results to prevent and reverse Osteoporosis-like disease. In contrast, the effects on the development of Osteoarthritis-like disease in ageing mice has been disappointing thus far. Here we review the literature and report novel data on the effect of geroprotectors for Osteoporosis and Osteoarthritis, we challenge the notion that extension of lifespan correlates with extension of healthspan in all tissues and we highlight the need for more thorough studies to test the effects of geroprotectors on skeletal health in ageing organisms.