Traditional systemic treatments have not fully met the needs of psoriasis patients: results from a national survey.
BACKGROUND
Many psoriasis patients are dissatisfied with current therapies. However, patient-centered levels of satisfaction with individual treatments have not been well described.


OBJECTIVE
To assess patients' satisfaction with 4 systemic treatment options available before 2002.


METHODS
We used data from a recent national survey. Psoriasis patients were randomly recruited from the general US population, members of the Psoriasis Foundation, and persons who contacted the Psoriasis Foundation but did not join. The interview included questions about use and satisfaction with specific Psoriasis therapy.


RESULTS
Of 1197 psoriasis patients interviewed, 311 (26%) indicated current or past use of methotrexate, psoralen plus ultaviolet A (PUVA), cyclosporin, and/or acitretin (users). Compared with those who had never used any of these systemic therapies, users reported more extensive disease (adjusted odds ratio [OR] = 2.90, 95% confidence interval [CI] = 1.87-4.49) and higher Psoriasis Disability Index scores (category V: adjusted OR = 2.31, 95% CI = 1.22-4.36). After adjusting for these variables, more than one third of patients were dissatisfied with each therapy, except for PUVA (14%). Patients were most satisfied with methotrexate and PUVA. However, less than 40% of the users indicated they were very satisfied with any of the 4 therapies assessed. Only 10% of persons who ever used cyclosporin were currently using it. In a paired analysis, cyclosporin users were significantly less satisfied with cyclosporin than with other therapies ( P = .01).


CONCLUSIONS
For most patients, none of the 4 systemic therapies widely utilized in 2002 for psoriasis were highly satisfactory. If we are to learn whether new treatments satisfy patients' needs, long term, prospective, comparative studies of heterogeneous patient populations that include patients' assessments are needed.
Nijsten
Tamar
T
Department of Dermatology at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Margolis
David J
DJ
Feldman
Steven R
SR
Rolstad
Tara
T
Stern
Robert S
RS
D017255:Acitretin / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D005363:Ficusin / Q000627:therapeutic use; D006306:Health Surveys; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011701:PUVA Therapy; D017060:Patient Satisfaction; D011565:Psoriasis / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D003879:Dermatologic Agents; D016572:Cyclosporine; D005363:Ficusin; D017255:Acitretin; D008727:Methotrexate