Undertreatment, Biologic Access Gaps Identified in Psoriasis Treatment

This content was produced independently by The American Journal of Managed Care^® and is not endorsed by the American Academy of Dermatology.

Two posters presented at the American Academy of Dermatology 2024 Annual Meeting show undertreatment of psoriasis remains a persistent issue in the US, especially when it comes to biologic medication use across socioeconomic status (SES) and insurance types.

Psoriasis | SergeVo - stock.adobe.com

The first poster explored trends within subpopulation and examined patterns in systemic treatment usage among individuals who have high impact locations and comorbidities.¹

The researchers conducted a cross-sectional online survey of a random sample of individuals from the National Psoriasis Foundation between 2020 and 2022. Eligible participants were 18 years or older living in the US with a diagnosis of psoriasis and/or psoriatic arthritis.

Patient Report of Extent of Psoriasis Involvement (PREPI) scores were used to measure body surface area affected by psoriasis, and undertreatment was evaluated by comparing type of treatment used in the last 12 months with current psoriasis severity and undertreatment trends, according to demographics and past estimates.

Treatment utilization did not differ based on biologic sex or race. Based on disease severity, the researchers found that a significant portion of individuals undertreated their disease. Moreover, 31.7% of individuals with moderate to severe psoriasis treated their disease using over the counter (31.7%), complimentary (12.2%), or topical (19.5%) therapy only.

Roughly one-third of participants with special location involvement and those with mild psoriasis and special location involvement reported use of only a topical therapy or over-the-counter medication (33% and 32.8%, respectively). Additionally, 25.7% of participants with inflammatory comorbidities and 28.4% of participants with mild psoriasis, current special location involvement, and an inflammatory comorbidity reported not using systemic treatments.

These findings suggest that undertreatment of psoriasis remans a persistent issue. Moreover, the study revealed how delayed systemic treatment is associated with a risk of irreversible negative outcomes.

A second poster evaluated the associations between SES, biologic medication usage, and secondary psoriasis outcomes.² Currently, nearly all biologic psoriasis medications are dispensed under brand names and have a significant prohibitive cost for patients with governmental insurance.

The community-based hospital patient cohort included a total of 770 inpatients being treated for psoriasis between 2013 and 2023. The researchers grouped patients according to their biologic utilization, with medication groups compared by age, cumulative comorbidity index, insurance, and length of stay (LOS).

A significant difference in utilization of biologic medication between insurance types was identified, in which 80% of patients who were treated with biologic medications had private insurance. Additionally, among patients who were treated with non-biologic medication, 52% had private insurance and 48% had Medicaid/Medicare.

Furthermore, the mean LOS among patients treated with biologic medications was 1.8 days, while the mean LOS among patients treated with non-biologic medications was 5.06 days (P < .05).

These findings suggest how individuals at lower income levels tend to have less access to biologic targeted therapies for psoriasis. Additionally, these findings also suggest that lower income status may contribute to a higher severity of psoriasis complications and worse outcomes.

References

1. Gondo G, Kumar I, Eakin G, et al. Undertreatment among patients with psoriasis in the United States: results from the 2022 National Psoriasis Foundation Annual Survey. Poster presented at: American Academy of Dermatology Annual Meeting 2024. March 8-12, 2024; San Diego, CA. Poster 51670. https://aad-eposters.s3.amazonaws.com/AM2024/poster/51670/Undertreatment+among+patients+with+psoriasis+in+the+United+States+Results+from+the+2022+National+Psoriasis+Foundation+Annual+Survey.pdf

2. Gilkey T, Lampley N, Salvator A, et al. Socioeconomic status correlates with increased use of biologic treatments. Poster presented at: American Academy of Dermatology Annual Meeting 2024. March 8-12, 2024; San Diego, CA. Poster 51395. https://aad-eposters.s3.amazonaws.com/AM2024/poster/51395/Socioeconomic+Status+Correlates+with+Increased+Use+of+Biologic+Treatments+and+Improved+Outcomes+in+Psoriasis+Patients.pdf