Dermatologists’ Views and Opinions about Photo(chemo)therapy and Conventional Systemic Psoriasis Therapies: Results from a Belgian Survey

Abstract

Background: Experts’ opinions about old and new psoriasis therapies are well documented. Objectives: To document the views and opinions of a large, diverse group of dermatologists about psoriasis treatment. Participants/Methods: A survey was conducted among Belgian dermatologists. In addition to demographic and professional characteristics, the questionnaire assessed the self-rated level of experience, frequency of use, preference and considerations regarding UVB, PUVA, methotrexate (MTX), cyclosporin (CsA) and acitretin. Multivariate logistic regression analyses were performed to investigate predictors of these dermatologist-based outcomes. Results: Of the 628 contacted dermatologists, 310 responded (response rate of 49.3%). The dermatologists were significantly more experienced with photo(chemo)therapy than with systemic agents (p ≤ 0.02); about half reported none or little experience with MTX and CsA. Also, photo(chemo)therapies were significantly more frequently used than systemic drugs (p ≤ 0.01). In the last year, almost 40% had not used and less than 10% had used MTX or CsA more than 10 times. Despite the limitations of PUVA, it was preferred to UVB, followed by acitretin (± phototherapy), and MTX and CsA were considered final options by most dermatologists. After adjusting for confounding variables, age, years in practice, seeing and treating more patients, residency programme and/or access to UV therapy were significantly associated with limited experience, regular use and/or preference of studied therapies. Conclusion: Either a substantial proportion of the dermatologists does not need or wish to use conventional systemic psoriasis therapies or they may need better and more uniform training during and after their residency. This may improve patient care and patient selection for other treatments.

Dermatologists’ Adherence to the Guideline of the Dutch Society of Dermatology and Venereology with Respect to the Treatment with Methotrexate for Severe Chronic Plaque Psoriasis: Results from a Dutch Survey

“…However, the response rate to our survey (49,8%) was at least as good as for similar surveys among dermatologists [1, 18, 19]. Furthermore, 91% of the respondents currently prescribed MTX for psoriasis patients and 80% of them said to use the guideline in their clinical practice.…”

“…These high numbers make the meaning of the results clearer. Furthermore, reimbursement of the expensive biologicals is restricted to ‘high-need’ psoriasis patients who may be defined using criteria that include disease severity and resistance and/or intolerance to a number of conventional therapies [18], like MTX. Also, in the future MTX will more and more be used in combination with one of these biologicals.…”

Expression of Tolerance Associated Gene-1, a Mitochondrial Protein Inhibiting T Cell Activation, Can Be Used to Predict Response to Immune Modulating Therapies

“…Moreover, biologics such as Alefacept are cost intensive and may cause side effects (3). Therefore, they are usually administered to patients who failed on conventional anti-inflammatory therapies (12). Severity of psoriasis is evaluated by the Psoriasis Area and Severity Index (PASI, 3 Ref.…”

Evaluation of the reimbursement criteria for biological therapies for psoriasis in the Netherlands

“…The findings of this Dutch survey suggest that failure to respond to UVB or PUVA, and methotrexate or ciclosporin, are preferable as reimbursement criteria. The preference to exclude ciclosporin as a criterion by about 70% of the responders may be explained by its risk/benefit profile, skin cancer‐promoting interaction with photo(chemo)therapy, national tradition and/or the observation that only a minority of dermatologists is comfortable using both methotrexate and ciclosporin in the treatment of psoriasis 3 . Also, from a patient safety perspective it is not ideal to acquire high doses of exposure to all psoriasis treatments because of interactions.…”