title: Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis.
abstract: BACKGROUND
  Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood.
  
  
  OBJECTIVE
  We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice.
  
  
  METHODS
  A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments.
  
  
  RESULTS
  A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95% confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72).
  
  
  CONCLUSIONS
  The study is limited by its reliance on patient recall.
  
  
  CONCLUSIONS
  Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.
authors: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors: Howa
authors: H
authors: Yeung
authors: Joy
authors: J
authors: Wan
authors: Abby S
authors: AS
authors: Van Voorhees
authors: Kristina
authors: K
authors: Callis Duffin
authors: Gerald G
authors: GG
authors: Krueger
authors: Robert E
authors: RE
authors: Kalb
authors: Jamie D
authors: JD
authors: Weisman
authors: Brian R
authors: BR
authors: Sperber
authors: Bruce A
authors: BA
authors: Brod
authors: Stephen M
authors: SM
authors: Schleicher
authors: Bruce F
authors: BF
authors: Bebo
authors: Daniel B
authors: DB
authors: Shin
authors: Andrea B
authors: AB
authors: Troxel
authors: Joel M
authors: JM
authors: Gelfand
mesh_terms: D017255:Acitretin / Q000627:therapeutic use; D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007641:Keratolytic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects / Q000191:economics; D017060:Patient Satisfaction; D011565:Psoriasis / Q000188:drug therapy* / Q000532:radiotherapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007641:Keratolytic Agents; D018124:Receptors, Tumor Necrosis Factor; D000068879:Adalimumab; D017255:Acitretin; D000068800:Etanercept; D008727:Methotrexate