Nontreatment, undertreatment of psoriasis and psoriatic arthritis still prevalent

Nontreatment and undertreatment of psoriasis and psoriatic arthritis appear to still be a significant problem in the United States, according to a study.

Researchers surveyed a random sample from a National Psoriasis Foundation database of more than 76,000 patients with psoriatic diseases from January 2003 through December 2011.

Results appeared online Aug. 14 at JAMA Dermatology.

There were 5,604 patients with psoriasis or psoriatic arthritis. Overall, 52.3% of patients with psoriasis and 45.5% of patients with psoriatic arthritis reported that they were dissatisfied with their treatment, according to study results.

During the survey years, the percentage of mild psoriasis patients who were untreated ranged from 36.6% to 49.2%; for moderate psoriasis, the range was 23.6% to 35.5%, and for severe psoriasis, the range was 9.4% to 29.7%.

Among those receiving treatment, those treated with topical agents alone included 29.5% of patients with moderate psoriasis and 21.5% of patients with severe psoriasis.

The most frequently used phototherapy was UV-B, which increased from less than 8.5% in 2003 to 33.2% in 2004. This rate held steady through the spring of 2005 and decreased to a mean of 11.2% from the fall of 2005 to the spring of 2011.

Methotrexate was the most commonly used oral agent, ranging from 9.8% to 14.5% from 2003 through 2011. From 2003 to 2009, acitretin use ranged from 0.7% to 4.2%, rising to 22.6% of patients in 2011. Cyclosporine was used in 0.5% to 2.3% of patients.

Top reasons for stopping biological agents included side effects, lack of efficacy and an inability to get insurance coverage.

The researchers noted that in 2011 almost half of patients with mild psoriasis, one-quarter of patients with moderate psoriasis, and almost one-tenth of patients with severe psoriasis didn't receive any treatment and that these figures among members of the National Psoriasis Foundation are likely more conservative than those among the general population.

They wrote, “Undertreatment also represents a significant problem. Approximately 30% of patients with moderate psoriasis and about 20% of patients with severe psoriasis receive topical medication alone. With the availability of multiple immune modulatory agents, ensuring that patients are offered these therapeutic options is paramount to improving patient outcomes.”