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Many Psoriasis Patients Are Undertreated, Study Finds

Inadequate treatment can have serious medical consequences (August 14)

According to a new study published online in JAMA Dermatology, many patients with psoriasis and psoriatic arthritis are not benefiting from the array of treatments that are available for these serious autoimmune disorders.

“The high proportion of patients who are not being treated, or are being inadequately treated, is a concern because psoriasis is much more than a cosmetic skin condition,” said lead author April W. Armstrong, MD, MPH. “It’s a serious and chronic medical disease.”

Patients with psoriasis are at high risk for heart attacks, diabetes, and premature death as well as joint inflammation leading to arthritis, she added.

Armstrong and her colleagues analyzed the responses of more than 5,600 randomly selected patients from 13 biannual surveys, which were conducted by the National Psoriasis Foundation (NPF) between 2003 and 2011.

The authors found that, during this period, the proportions of untreated patients ranged from 37 percent to 49 percent of those with mild psoriasis; 24 percent to 36 percent of those with moderate psoriasis; and 9 percent to 30 percent of those with severe psoriasis. Among patients receiving treatment, 30 percent with moderate psoriasis and 22 percent with severe psoriasis were treated with topical agents alone.

Although adverse effects and a lack of effectiveness were primary reasons for discontinuing biological agents, the inability to obtain adequate insurance coverage was among the top reasons for discontinuation. Overall, 52 percent of patients with psoriasis and 46 percent of patients with psoriatic arthritis were dissatisfied with their treatment, according to the study results.

To help address the treatment challenges for patients with psoriasis or psoriatic arthritis, the authors encourage more patient advocacy, especially directed at payers, such as Medicare and insurance companies. They also emphasize the need for more patient education and awareness about the risk of cardiovascular disease.

“We want payers to understand the serious medical consequences of non-treatment and under-treatment of psoriasis and psoriatic arthritis,” Armstrong said.

Sources: UC Davis Health System; August 14, 2013; and JAMA Dermatology; August 14, 2013.

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