Race, Ethnicity May Not Affect Biologic Prescribing Patterns for Psoriasis

Although Black patients are reportedly less likely than others to receive biologics for the treatment of psoriasis, a new survey suggests the disparity is not necessarily the result of prescribing decisions by dermatologists.¹

These findings were presented at the 2023 American Academy of Dermatology Annual Meeting, in New Orleans.

Although biologics have significantly changed the therapeutic landscape for people with psoriasis, previous research suggests that the benefits of these advances have not been felt equally across racial and demographic groups. For instance, a 2015 study found that Black patients on Medicare were 69% less likely than White patients to receive biologics for psoriasis,² and earlier studies suggest that a lack of knowledge about biologics and concerns about the high cost of the medications might be among the reasons for the disparity.

In the new report, researchers wanted to know what role—if any—the prescribing decisions of dermatologists might play in the disparity. To find out, they sent a survey to more than 10,000 dermatologists in the United States asking them to make prescribing choices based on descriptions of patient scenarios. Each of the scenarios described a patient with moderate to severe psoriasis and mentioned the race or ethnicity of the patient: White, Black, or Hispanic.

Physicians were asked to choose 1 of 5 options for each patient: start topical steroids, start a biologic, start oral methotrexate, postpone treatment until a 3-month follow-up, or start phototherapy. In addition to choosing from the multiple-choice menu, respondents could explain their choice in a free-text field on the survey.

A total of 525 dermatologists completed the survey. In most cases, they prescribed either a biologic or a topical therapy. For instance, in the 172 scenarios involving White patients, physicians prescribed topical therapies 51% of the time and biologics 30% of the time. Phototherapy and oral methotrexate were prescribed in 16% to 19% of cases (combined), depending on the racial or ethnic group. Across all 3 demographic groups, delayed treatment was only chosen by dermatologists 1% of the time.

Yet, the data did not show significant demographic-based disparities in prescribing decisions. Black patients were prescribed biologics 38% of the time, Hispanic patients were prescribed biologics 31% of the time, and White patients were given biologics 30% of the time.

Similarly, there was not a significant difference in how much time physicians took to make their decisions. When reading scenarios about Black patients, physicians took a median of 93.8 seconds to make their choice, similar to the 92.2 seconds they took when considering scenarios about White patients. When making decisions about Hispanic patients, physicians took a median of 82.7 seconds, but the authors said that difference did not reach statistical significance.

In examining the free-text fields, physicians were more likely to mention cost and insurance when making prescribing decisions for Hispanic patients compared with Black patients. However, there was not a significant difference in the rate of mentioning cost and insurance for Black or Hispanic patients vs White patients.

Thus, the investigators concluded that concerns about cost and insurance might affect the rate at which Hispanics receive biologics, even if it does not affect the rate at which dermatologists recommend them to Hispanic patients.

References

1. Petion E, van Egmond S, de Vere Hunt I, et al. Racial and ethnic differences in prescribing patterns for Psoriasis: a survey of 525 U.S. dermatologists. Poster presented at: AAD 2023; March 17-21, 2023; New Orleans, LA. https://bit.ly/3JS86Yz

2. Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use.J Invest Dermatol. 2015;135(12):2955-2963. doi:10.1038/jid.2015.296