title: Treatment adherence and real-life effectiveness of topical therapy in patients with mild or moderate psoriasis: uptake of scientific evidence in clinical practice and dermatologists' preferences for alternative treatment options.
abstract: OBJECTIVE
  Topical corticosteroids and the vitamin D analogue calcipotriol are the cornerstone of therapy for patients with mild-to-moderate plaque psoriasis. Lack of patients' adherence leads to suboptimal effectiveness of topical therapy in real-life practice. The fixed combination betamethasone/calcipotriol gel is more effective and safe than the administration of single components and may enhance patients' adherence. We aimed at evaluating the pattern of care and dermatologists' expert opinion toward the available topical treatments for the management of mild-to-moderate psoriasis in Italy.
  
  
  METHODS
  We enrolled 242 Italian dermatologists and collected information related to their practice pattern and opinion toward available topical treatments with a face-to-face structured interview. We evaluated dermatologists' ratings of therapy with 16 items tapping their opinion toward the relevance and satisfaction toward 8 therapy attributes in clinical practices which tapped aspects of real-life effectiveness, adherence promotion, toxicity, convenience of use. Ratings occurred along a 10-point scale. We compared single-attribute and weighted overall therapy ratings across alternative treatment options with random-intercept linear models to account for ratings clustering within dermatologists.
  
  
  RESULTS
  There was a wide variation in practice patterns: 1/3 of dermatologist had seen more than 30 patients with psoriasis while around 1/4 had seen less than 10 patients. The fixed combination betamethasone/calcipotriol gel was considered superior to monotherapies in all the eight attributes considered which tapped aspects of real-life effectiveness, adherence promotion, toxicity, convenience of use.
  
  
  CONCLUSIONS
  Participant dermatologists' strongly preferred the fixed betamethasone/calcipotriol combination gel over both the fixed combination ointment formulation and corticosteroid or vitamin D analogues monotherapies. Such findings are in line with evidence from randomized controlled trials and few observational studies demonstrating superior clinical outcomes, quality of life, tolerability and lower risk of side effect in patients treated with the fixed combination of betamethasone/calcipotriol gel.
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italia - luca.neri@unimi.it.
authors.forename: L
authors.initials: L
authors.lastname: Neri
authors.forename: A
authors.initials: A
authors.lastname: Miracapillo
mesh_terms: D000279:Administration, Cutaneous; D001291:Attitude of Health Personnel; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002117:Calcitriol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003880:Dermatology / Q000706:statistics & numerical data; D004338:Drug Combinations; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D055118:Medication Adherence; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy*; D011788:Quality of Life
chemical_list: D003879:Dermatologic Agents; D004338:Drug Combinations; D005938:Glucocorticoids; C055085:calcipotriene; D001623:Betamethasone; D002117:Calcitriol