Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring.
BACKGROUND
Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short-term adherence. Psoriasis is a chronic disease, and long-term adherence is an even bigger problem.


OBJECTIVE
To determine how well medication is used in the long-term topical treatment of psoriasis and to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes.


METHODS
An investigator-blinded, prospective study evaluated topical fluocinonide adherence in 40 patients with mild-to-moderate psoriasis over 12 months. Subjects were randomized in a 1 : 1 ratio to standard-of-care or internet-based reporting group. Adherence was objectively monitored with Medication Event Monitoring System®caps.


RESULTS
Fifty per cent of subjects discontinued the treatment. Greater adherence was seen in the intervention group compared with the standard-of-care group (50% vs. 35%, P = 0·08). Psoriasis Area and Severity Index improved more in the intervention group at month 1 (1·61 vs. -0·12, P = 0·003), month 3 (2·50 vs. 0·79, P = 0·025) and month 12 (3·32 vs. 0·34, P = 0·038) than in the standard-of-care group.


CONCLUSIONS
This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes.
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
H
H
Alinia
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
S
S
Moradi Tuchayi
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
J A
JA
Smith
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
I M
IM
Richardson
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.|Department of Biomedical Engineering, Virginia Tech-Wake Forest University, Winston-Salem, NC, U.S.A.|Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
N
N
Bahrami
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
S C
SC
Jaros
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
L F
LF
Sandoval
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
M E
ME
Farhangian
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
K L
KL
Anderson
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
K E
KE
Huang
Department of Dermatology (Center for Dermatology Research), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.|Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.|Department of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, U.S.A.
S R
SR
Feldman
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003879:Dermatologic Agents / Q000008:administration & dosage*; D057286:Electronic Health Records; D005260:Female; D005447:Fluocinonide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D055815:Young Adult
D003879:Dermatologic Agents; D005447:Fluocinonide