A patient‐centred approach to biological treatment decision making for psoriasis: an expert consensus

Abstract

BackgroundEach individual psoriasis patient has different expectations and goals for biological treatment, which may differ from those of the clinician. As such, a patient‐centred approach to treatment goals remains an unmet need in psoriasis.ObjectiveThe aim of this study was to review available data on patients’ and physicians’ decision criteria and expectations of biological treatment for moderate‐to‐severe psoriasis with the aim of developing a core set of questions for clinicians to ask patients routinely to understand what is important to them and thus better align physicians’ and patients’ expectations of treatment with biologics and its outcomes.MethodsA literature search was conducted to identify key themes and data gaps. Aspects of treatment relevant when choosing a biological agent for an individual patient were identified and compared to an existing validated instrument. A series of questions aimed at helping the physician to identify the particular aspects of treatment that are recognised as important to individual psoriasis patients was developed.ResultsKey findings of the literature search were grouped under themes of adherence, decision‐making, quality of life, patient/physician goals, communication, patient‐reported outcomes, satisfaction and patient benefit index. Several aspects of treatment were identified as being relevant when choosing a biological agent for an individual patient.The questionnaire is devised in two parts. The first part asks questions about patients’ experience of psoriasis and satisfaction with previous treatments. The second part aims to identify the treatment attributes patients consider to be important and may as such affect their preference for a particular biological treatment. The questionnaire results will allow the physician to understand the key factors that can be influenced by biological drug choice that are of importance to the patient. This information can be used be the physician in clinical decision making.ConclusionThe questionnaire has been developed to provide a new tool to better understand and align patients’ and physicians’ preferences and goals for biological treatment of psoriasis.

The burden of skin disease in the United States

“…Examples include new topical medications for acne, biologics and excimer laser for psoriasis, checkpoint inhibitors for melanoma, and oral and systemic treatments for cutaneous lymphoma. 49,[58][59][60][61][62] Since 2013, costs of many widely used dermatologic medications have increased significantly, and better understanding of the pathophysiology of diseases has led to development of new medications. Therefore, the health care cost of skin disease at the time of writing this article most likely surpasses this 2013 estimation.…”

Rapid Response of Biologic Treatments of Moderate-to-Severe Plaque Psoriasis: A Comprehensive Investigation Using Bayesian and Frequentist Network Meta-analyses

“…However, rapid effect is also tied to longer-term outcomes, including skin improvement, quality of life, and reduction in itch [50,[53][54][55], though it must be noted that an association between rapid effect and long-term outcomes was not assessed in this analysis. It is also important to note that each patient has different treatment expectations [51,56] and that the alignment of individual patient needs with physician goals may improve adherence and satisfaction with therapy [56].…”

Clinical Goals and Barriers to Effective Psoriasis Care

“…In the majority of cases, patient expectations are influenced by the clinician, but neither the patient nor the clinician may be fully aware of what the patient believes is most important. Dermatologists are generally calibrated to patient expectations that are highly related to factors such as age, gender, socioeconomic status, occupation, and geographic locale [ 36 ]. In a German registry, patients surveyed reported a wide range of highly valued treatment goals beyond skin clearance, which included improvement of itching, burning, and pain and normal life functioning [ 37 ].…”