AT WCD 2015
VANCOUVER, B.C. (FRONTLINE MEDICAL NEWS) – The largest-ever survey of North American and European physician and patient perspectives on psoriasis and psoriatic arthritis reveals a major disconnect between dermatologists and their psoriasis patients regarding the importance of pruritus.
Dermatologists characterized one-fifth of their psoriasis patients as having severe disease. The majority of dermatologists – fully 53% – regarded lesion size and location to be the most important factors contributing to disease severity. Only 7.4% of dermatologists considered itch to be the most important factor.
In contrast, 38% of patients considered itching to be the most important aspect of their skin disease, and 17% – less than one-third of the proportion of dermatologists – rated lesion size and location to be the top contributor to disease severity, Dr. Peter van de Kerkhof reported at the World Congress of Dermatology.
He presented new findings from the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP), a survey of North American dermatologists, rheumatologists, psoriasis patients, and psoriatic arthritis patients unrivaled in its scope. The results of the first part of the survey, which entailed contacting 139,000 households and focused on unmet needs as characterized by 3,426 patients, have already been published ( J. Am. Acad. Dermatol. 2014;70:871-81 ).
At the WCD, Dr. van de Kerkhof presented highlights of part 2 of the MAPP survey, which sought to obtain the real-world perspectives of dermatologists and rheumatologists on the management of psoriasis and psoriatic arthritis. Of the 6,530 dermatologists and 5,445 rheumatologists who were contacted, 391 and 390, respectively, completed the detailed interview, according to Dr. van de Kerkhof, professor and chairman of the department of dermatology at Radboud University in Nijmegen, the Netherlands.
Although 92% of dermatologists agreed that the disease burden of psoriasis is frequently underestimated, the marked physician/patient divergence regarding the importance of pruritus was particularly striking, he observed.
Nineteen percent of dermatologists reported that their patients with moderate to severe psoriasis were receiving conventional oral agents, and 19.6% indicated their patients were on biologic therapy. However, 54% of dermatologists indicated they prescribed topical agents as monotherapy for their patients with moderate to severe disease, which is out of step with current treatment guidelines and represents clear undertreatment, Dr. van de Kerkhof noted.
Thirty-six percent of dermatologists cited affordability and 22% cited uncertainty about long-term safety of current medications as the greatest challenge associated with management of psoriasis. Sixteen percent cited lack of effectiveness as the biggest challenge.
The top reasons dermatologists gave for not initiating treatment with conventional oral agents were concerns about long-term safety and tolerability. Those were also the main reasons dermatologists gave for not continuing conventional oral medications.
The story was slightly different when it came to reasons for not initiating or continuing biologic agents. Here cost joined tolerability and long-term safety concerns as the main reasons for not starting patients on biologic therapies. Those factors, along with lack or loss of response, which was cited by 18% of dermatologists, were also the chief reasons given for not continuing patients on biologic agents.
Dr. Gil Yosipovitch, who has devoted much of his research career to the study of itch, predicted that the sharp discrepancy between psoriasis patients and dermatologists regarding the importance of itch as documented in the new MAPP survey findings will improve soon. Dermatologists’ attitudes towards itch are beginning to change: “If you look at the textbooks of a decade ago, itch was not even mentioned as part of the symptoms,” he said.
Psoriasis patients clearly feel that effective treatment for their pruritus is an unmet need. Fortunately, studies on the itch impact of current and next-generation biologics are underway and in some cases completed, noted Dr. Yosipovitch, professor and chair of the department of dermatology at Temple University in Philadelphia.
The MAPP survey was sponsored by Celgene Corp. Dr. van de Kerkhof reported serving as a consultant to Celgene and a dozen other pharmaceutical companies, most of which also provide him with grants to conduct clinical trials.