Psoriasis Disease Severity Affects Patient Satisfaction With Therapy

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1 82 Psoriasis Disease Severity Affects Patient Satisfaction With Therapy Korman NJ 1, Zhao Y 2, Tran MH 2, Lu J 2 (Please see authors affiliations on the last panel) Background Psoriasis is a chronic, immune mediated inflammatory disease of the skin, which typically manifests itself as raised scaly plaques that may be painful, itchy, and burning 1,2 Psoriasis affects approximately 3% of the US population 3 This lifelong disease currently has no cure, but a range of treatments is available that provides varying degrees of symptom alleviation and temporary disease control 4 However, more than half of patients with psoriasis are not content with current treatment choices and desire improved outcomes 5,6 Hence, factors that contribute to patient satisfaction with therapy are important to consider when choosing among treatments for psoriasis

2 Study Design Study Objective Examine relationships between psoriasis overall disease severity (mild, moderate to severe) and patient demographics, disease characteristics, and satisfaction with therapy among patients with psoriasis in the United States Data Cross sectional analyses performed using syndicated data from the Psoriasis Wave 5 Survey, to which respondents were recruited from the National Health and Wellness Survey (NHWS; both surveys: Kantar Health, New York, NY, USA) Sample Selection 5,605 potential respondents were invited to complete the Psoriasis Wave 5 Survey o 1,635 accepted (response rate, 29%) o 585 dropped out during the survey or did not meet the screening criteria 1,0 respondents completed the survey 773 reported receiving treatment for psoriasis and were included in the analysis Study Cohort: Self Reported Overall Disease Severity Respondents answered the following question: "How would you currently characterize the severity of your psoriasis? o Severity level choices: mild, moderate, or severe For analysis purposes, moderate and severe were combined into one single category National Health and Wellness Survey Annual, self administered, healthcarerelated survey of US adults N = ~75,000 Random sampling Representative of US population Psoriasis Wave 5 Survey 5,605 potential respondents invited from NHWS Aged years Self reported psoriasis 1,635 accepted 1,0 completed* 773 analyzed Received psoriasis treatment *585 dropped out or did not meet screening criteria. 2

3 Patients With Moderate-to-Severe Psoriasis Were Younger, Had More Biologic Use, and Were More Affected by Comorbidities Patient Characteristics and Comorbid Conditions Psoriasis Severity All Patients Mild Moderate to Severe Characteristics (N = 773) (n = 7) (n = 366) Age, years mean (SD) 54.3 (13.9) 56.2 (13.3) 52.2 (14.2)* Age category n (%) years 145 (18.8) 62 (15.2) 83 (22.7)* years 4 (54.3) 214 (52.6) 6 (56.3) 65 years 8 (26.9) 131 (32.2) 77 (21.0) Female n (%) 433 (56.0) 2 (55.8) 6 (56.3) White n (%) 690 (89.3) 372 (91.4) 318 (86.9) College degree or higher n (%) 411 (53.2) 233 (57.2) 178 (48.6) Received biologic therapy n (%) 160 (.7) (7.4) 1 (35.5)* Comorbidities Anxiety 141 (18.2) 65 (16.0) 76 (.8) Depression 176 (22.8) 81 (19.9) 95 (26.0) Heart disease 76 (9.8) 41 (10.1) 35 (9.6) Insomnia 91 (11.8) 33 (8.1) 58 (15.8)* Joint pain 221 (28.6) 102 (25.1) 119 (32.5) Osteoarthritis 159 (.6) 81 (19.9) 78 (21.3) Psoriatic arthritis 107 (13.8) 34 (8.4) 73 (19.9)* Type 2 diabetes mellitus 131 (16.9) 66 (16.2) 65 (17.8) SD, standard deviation. *p 0.001, p <0.05 compared with mild psoriasis group. 3

4 Patients With Moderate-to-Severe Psoriasis Experienced More Severe Symptoms and Were More Frequently Bothered by Their Symptoms All (N=773) Mild Psoriasis (n=7) Moderate/Severe Psoriasis (n=366) 90 Percent of Patients Pain without flare ups Pain with flare ups Bothered by itching Bothered by burning/stinging Bothered by hurting Bothered by irritation 4

5 More Patients With Mild Psoriasis Were Satisfied With Existing Treatment Patient Satisfaction With Current Psoriasis Treatment a All (N=773) Mild Psoriasis (n=7) Moderate to Severe Psoriasis (n=366) Percent of Patients * 34 * * Symptom alleviation Consistent symptom control QOL improvement Fast acting product Long term costeffectiveness Emotional health improvement QOL, quality of life. a Treatment categories were over the counter, topical, oral, phototherapy, and biologic. *P 0.001, P <0.05 compared with mild psoriasis group. 5

6 Satisfaction With Current Psoriasis Therapy Was Generally Higher Among Patients Who Used a Biologic Patient Satisfaction With Current Psoriasis Treatment: Biologics vs Non biologics Biologics Users Non Biologics Users All (n=160) Mild Psoriasis (n=) Mod/Sev Psoriasis (n=1) All (n=706) Mild Psoriasis (n=385) Mod/Sev Psoriasis (n=321) Percent of Patients Percent of Patients

7 Mild Psoriasis Was Significantly Associated With Greater Satisfaction With Current Treatment Predictors of Patient Satisfaction Variable Moderate to severe psoriasis Biologic treatment Oral treatment Topical treatment Phototherapy OTC treatment Symptom Alleviation 0.65 (0.47, 0.90)* 1.17 (0.75, 1.82) 1.44 (0.76, 2.71) 1.69 (1.15, 2.47)* 1.22 (0.78, 1.91) 1.71 (1.15, 2.55)* Fast acting Product Consistent Symptom Control QOL Improvement Odds Ratio (95% Confidence Interval) (0.42, 0.91) (0.34, 0.68) (0.80, 1.76) 1.90 (1.14, 3.17) 1.37 (0.86, 2.) 0.70 (0.32, 1.55) 1.17 (0.61, 2.26) Emotional Health Improvement 1.22 (0.73, 2.05) (2.01, 5.22) (0.65, 2.38) 1.06 (0.53, 2.11) (1.10, 2.73) (1.11, 2.47) (0.74, 1.77) 0.74 (0.43, 1.28) 0.90 (0.56, 1.43) 1.06 (0.66, 1.68) 1.44 (0.96, 2.15) 3.15 (1.47, 6.77)* 1.09 (0.61, 1.94) 1.68 (1.02, 2.74) 2.53 (1.43, 4.47)* 0.73 (0.45, 1.19) 0.76 (0., 1.43) Long term Cost effectiveness 0.57 (0.38, 0.86)* 1.67 (0.98, 2.84) 1.41 (0.69, 2.86) 1.33 (0.85, 2.10) 1.22 (0.72, 2.05) 1.26 (0.79, 2.00) OTC, over the counter; QOL, quality of life. Additional variables included in the model were age, gender, education, ethnicity, and comorbidities (anxiety, depression, heart disease, insomnia, joint pain, osteoarthritis, psoriatic arthritis, and type 2 diabetes mellitus). *P<0.01; P<0.001; P<0.05 compared with corresponding reference group. 7

8 Conclusions Overall satisfaction with existing treatments for psoriasis was higher among patients with mild versus moderate to severe psoriasis Patients who used biologics for treatment of psoriasis reported greater satisfaction with current therapy than the patients who did not use biologics References 1. Langley RGB et al. Ann Rheum Dis. 05;64(suppl II):ii18 ii Nestle FO et al. N Engl J Med. 09;361: Rachakonda TD et al. J Am Acad Dermatol. 14;70: Pariser DM et al. Arch Dermatol. 07;143: Stern RS et al. J Investig Dermatol Symp Proc. 04;9: Armstrong AW et al. JAMA Dermatol. 13;149: Author affiliations: 1 University Hospitals Case Medical Center, Cleveland, OH Novartis Pharmaceuticals Corporation, East Hanover, NJ This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. The authors thank BioScience Communications for editorial assistance. Disclosures: N. Korman, received grant funding for his participation in this project; investigator for Abbvie, Amgen, Celgene, Eli Lily, Genentech, Janssen, and Pfizer; advisory boards for Amgen, Astellas, Baxter, Celgene, Eli Lily, Genentech, Janssen, Novartis, and Pfizer; consultant for Apopharma and Astellas; speaker for Abbvie, Amgen, Astellas, Genentech, and Janssen; Y. Zhao, employee of Novartis Pharmaceuticals Corporation; M.H. Tran, was employees of Novartis Pharmaceuticals Corporation when the study was conducted; J. Lu, was fellow of Novartis Pharmaceuticals Corporation when the study was conducted. 8