Armstrong AW, Jayade S, Rege S, Penton H, Patel V, Davidson D, Kalirai S, Wolin D, Boyle K, Seigel L. Evaluating prevalence and consequence of residual disease among patients with moderate to severe psoriasis in the United States. Poster presented at the Maui Derm Hawaii 2023; January 23, 2023. Maui, HI.

BACKGROUND: Psoriasis is a chronic inflammatory condition that diminishes patients’ quality of life (QoL). Treatments are available, yet evidence reveals unmet needs. This study assessed the prevalence of, and factors associated with residual disease among patients with moderate to severe psoriasis receiving apremilast treatment, and compared clinical and humanistic burden among apremilast users who experience residual disease versus those who do not.

METHODS: This non-interventional, cross-sectional, online survey study among adult patients in the United States collected information about demographic and clinical characteristics, current treatment, prevalence of residual disease, flare-ups, humanistic burden (via the Dermatology Life Quality Index [DLQI], the Work Productivity and Activity Impairment Questionnaire–Psoriasis [WPAI-PSO], and questions on disease-related anxiety and depression), and healthcare resource use (HCRU). Patients were defined as experiencing residual disease if they responded ≥3 on the Body Surface Area scale or reported moderate, severe, or very severe psoriasis on a 6-point psoriasis severity scale. Respondents were also shown a profile of a hypothetical new once-daily oral treatment and asked about their anxiety associated with it. Data were analyzed descriptively. Bivariate comparisons evaluated differences across groups.

RESULTS: The study included 344 apremilast users (mean age, 44.9 [±12.7] years; female, 65.4%; White, 72.4%). Among these patients, 50.6% had ≥3% BSA or at least moderate severity over the past week. Patients were significantly more likely to experience residual disease if they were Black (OR=4.5, 95% CI=1.6-12.2) versus White; if their treatment duration was ≥1 year (OR=16.5, 95% CI=7.9-34.4) versus <1 year; if they had ≥2 flare-ups (OR=10.0, 95% CI=4.9-20.1) versus 0-1 flare-ups in the past 3 months; and if they had ≥4 body regions affected (OR= 8.6, 95% CI=3.8-19.8) versus 1-3. The mean (SD) number of flare-ups in the past 3 months was greater among apremilast users with residual disease (4.7 [±7.6]) than those without (0.9 [±1.1]) (P<0.001). A higher percentage of apremilast users with residual disease experienced anxiety (89.7% versus 50.0%) and depression (69.0% versus 23.6%) over the past 30 days versus those without (P<0.001). A higher percentage of apremilast users with residual disease reported experiencing anxiety for several days or more (94.9% vs 78.8%) over the past 30 days than those without (P=0.001). Patients with residual disease also reported experiencing greater depression severity (very depressed, depressed) compared to those without (23.0% versus 4.2%) (P<0.001). When shown a hypothetical once-daily oral psoriasis treatment, 71.8% of apremilast users with residual disease said it would cause less anxiety than a treatment given as an injection/infusion. Apremilast users with residual disease had significantly higher mean DLQI and WPAI scores versus those without, indicating lower QoL and productivity (P<0.001). These patients also had higher allcause and psoriasis-related HCRU than those without residual disease.

CONCLUSIONS: Among apremilast users, those with residual disease reported more flare-ups, worse QoL, anxiety, depression, and work productivity, and greater HCRU compared with those without residual disease. We recommend physicians to evaluate residual disease among psoriasis patients on treatment in order to identify alternative treatment options that may mitigate clinical and humanistic burden.

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