title: Significant delay in the introduction of systemic treatment of moderate to severe psoriasis: a prospective multicentre observational study in outpatients from hospital dermatology departments in France.
abstract: BACKGROUND
  There is a low rate of systemic treatment usage in moderate to severe psoriasis.
  
  
  OBJECTIVE
  The primary objective of the present study was to assess the time period between lack of control of moderate to severe psoriasis with topical treatment or phototherapy as perceived by patients and the medical decision to introduce a systemic treatment.
  
  
  METHODS
  This was a prospective multicentre study, which included patients with moderate to severe psoriasis. A standardized questionnaire was completed by physicians and patients at the time the decision was taken to introduce a systemic treatment. The primary outcome was the duration of uncontrolled psoriasis, as estimated by the patient, prior to the introduction of systemic treatment. Factors associated with a delay in systemic treatment defined as > 2 years of uncontrolled psoriasis were assessed. The agreement between patients and physicians on the duration of uncontrolled psoriasis was estimated.
  
  
  RESULTS
  The study included 142 patients. The mean age was 48 years, the mean Psoriasis Area and Severity index (PASI) was 18·5 and the mean Dermatology Life Quality Index (DLQI) was 12. The median duration of uncontrolled psoriasis estimated by patients and physicians was 3 years and 2 years, respectively. Factors associated with a delay in the introduction of systemic treatment as assessed by patients were fewer than three physician visits since psoriasis was uncontrolled [odds ratio (OR) 3·05; 95% confidence interval (CI) 1·29-7·21], Hospital Anxiety and Depression (HAD) scale < 10 (OR 2·83; 95% CI 1·19-6·71), continuous psoriasis evolution (OR 2·67; 95% CI 1·12-6·42), low consumption of topical treatment (OR 2·35; 95% CI 1·03-5·34).
  
  
  CONCLUSIONS
  There is a significant delay in the introduction of systemic treatment in moderate to severe psoriasis. Patients with low level anxiety and limited use of healthcare resources appear to be at higher risk of experiencing long delays.
authors.affiliation: Université Paul Sabatier, Service de Dermatologie, Hôpital Larrey, UMR CNRS 5165-INSERM 1056 Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Maza
authors.forename: M A
authors.initials: MA
authors.lastname: Richard
authors.forename: F
authors.initials: F
authors.lastname: Aubin
authors.forename: J P
authors.initials: JP
authors.lastname: Ortonne
authors.forename: S
authors.initials: S
authors.lastname: Prey
authors.forename: H
authors.initials: H
authors.lastname: Bachelez
authors.forename: M
authors.initials: M
authors.lastname: Beylot-Barry
authors.forename: C
authors.initials: C
authors.lastname: Bulai-Livideanu
authors.forename: M
authors.initials: M
authors.lastname: Lahfa
authors.forename: J
authors.initials: J
authors.lastname: Nougué
authors.forename: X
authors.initials: X
authors.lastname: Mengual
authors.forename: M
authors.initials: M
authors.lastname: Le Moigne
authors.forename: V
authors.initials: V
authors.lastname: Lauwers-Cances
authors.forename: C
authors.initials: C
authors.lastname: Paul
mesh_terms: D000553:Ambulatory Care; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents