Evolution of Patient Perceptions of Psoriatic Disease: Results from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) Survey

Abstract

Introduction Since the 2012 Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey, several systemic treatments for psoriasis (PsO) and/or psoriatic arthritis (PsA) have been approved. The population-based UPLIFT survey was conducted to understand how perceptions of treatment-related outcomes have evolved, particularly for patients with mild to moderate PsO and/or PsA and their dermatologists. Methods This population- and web-based survey was conducted from 2 March to 3 June 2020, in North America, Europe, and Japan. Adults with self-reported healthcare practitioner (HCP)-diagnosed PsO and/or PsA and dermatologists who spent > 50% of time treating patients and treated ≥ 20 patients with PsO, including plaque PsO, per month were included. Patient participants were recruited at random from online panels; dermatologists were recruited randomly from representative physician panels. Results Of 264,054 patient responses, 3806 who self-reported an HCP diagnosis of PsO and/or PsA were included in the final sample; 67% had PsO alone, 28% had PsO and PsA, and 5% had PsA alone. The estimated population prevalence of psoriatic disease was 7% (PsO only: 4%; PsO and PsA: 2%; PsA only: 1%). Most patients (78%) reported PsO-involved body surface area (BSA) ≤ 3 palms, and ~ 90% or more reported itching, redness, flaking, and scales. Many PsO patients without diagnosed PsA reported musculoskeletal symptoms suggestive of PsA (63%). Across BSA categories, approximately one in four patients was not currently receiving treatment and > 50% had Dermatology Life Quality Index score > 5. Patients and dermatologists had different perceptions of PsO severity, office visit discussions, treatment goals, and treatment satisfaction. The survey was conducted during the coronavirus disease 2019 (COVID-19) pandemic, which could have affected assessments of patient-reported outcomes and ability to have in-person HCP visits. Conclusions Patients with PsO and PsA in UPLIFT reported high disease burden, including patients with limited skin involvement. An opportunity exists to align patient and dermatologist perceptions to optimize management of PsO and PsA. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00635-4.

Patient perceptions of psoriatic disease in Japan: Results from the Japanese subgroup of the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey

“…The methodology and design of the UPLIFT survey have been reported previously. 11 The survey was developed with input from a steering committee consisting of international experts in dermatology and rheumatology, and conducted by the AplusA Bell Falla (AABF) between 2 March and 3 June 2020. The protocol was approved by a central institutional review board (IRB) in the USA to comply with human subject research requirements.…”

“…In alignment with the overall population, custom and validated patient assessments in this subanalysis included respondent demographics and clinical characteristics; presence of PsO in all areas and in areas of high disease burden (i.e., genital, nail, scalp, palms, and soles); musculoskeletal/PsA symptoms; Psoriasis Epidemiology Screening Tool (PEST) scores; 24 self-reported skin involvement by PsO-involved body surface area (BSA) (assessed by number of palms, based on the palm width of the hand including fingers); self-rated current disease severity on a visual analog scale (1-3 = mild, 4-6 = moderate, 7-10 = severe); Dermatology Life Quality Index (DLQI); and current treatment. 11 Treatment options asked in the survey were topical therapies (over-the-counter or prescription topical medications), oral therapies (over-the-counter or prescription oral medications), biologic therapy (injectable or i.v. medications), phototherapy or lightbased treatment, and other (the respondent was asked to specify).…”

“…1,[6][7][8][9] Systemic therapies can also be used for localized PsO involving special areas, such as the scalp, palms, soles, and genitals, 1,10 and in patients with mild-to-moderate PsO who have musculoskeletal symptoms (although joint involvement often goes unrecognized). 11,12 When defining disease severity and selecting treatment, current guidelines and international expert consensus statements recommend considering symptoms, objective measures of disease severity, response to topical treatment, involvement of areas associated with high disease burden that negatively affects patient QoL (e.g., joint involvement, and involvement of the "special areas" of the face, palms, soles, scalp, nails, and genitalia), and impact of psoriatic disease on patient QoL. 8,9,13,14 The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey, a population-based survey conducted in Europe and North America in 2012, revealed that even patients with limited skin involvement experienced substantial disease burden and impact on QoL, and many patients with PsO and/or PsA were undertreated (i.e., receiving no treatment or topical treatment alone).…”

“…9,[15][16][17] The recent Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey conducted in 2020 reported that globally there was still persistently high disease burden and undertreatment of patients with PsO and/or PsA. 11 In Asian countries, including Japan, patients with PsO may experience high levels of social stigma and discrimination for cultural and socioeconomic reasons, 18 and the impact of PsO on patient QoL in these countries may be even greater than that observed in Western countries. The limitations of topical therapies, including inconvenience and difficulty with application (particularly for patients with PsO in special areas), as well as perceived poor efficacy and fear of corticosteroid-associated adverse effects, 2,19,20 may contribute to low satisfaction with topical treatment observed in surveys of Japanese patients, 9,21 and poor QoL.…”

Therapeutic Inertia in the Management of Psoriasis: A Quantitative Survey Among Indian Dermatologists and Patients

“…6 The overall quality of life (QoL) of patients with psoriasis is significantly impacted due to disease severity, gender, age, anatomical sites of lesion, and involvement of comorbidity; [7][8][9] leading to multifaceted effects on patients life including social exclusion, discrimination, physical and psychological well-being, and loss of productivity. [10][11][12][13][14][15][16][17][18][19][20][21] Patients with psoriasis are categorised as mild, moderate and severe based on the severity of disease and percentage of body surface affected. 22 The treatment for psoriasis is generally a long-term therapy wherein patients with moderate-to-severe psoriasis need systemic treatment (such as methotrexate, acitretin & biologics), whereas for mild psoriasis, topical medications (such as corticosteroids and vitamin D3 analogues) and phototherapy are generally preferred.…”