Unmet Need in People with Psoriasis and Skin of Color in Canada and the United States

Yadav, Geeta; Yeung, Jensen; Miller-Monthrope, Yvette; Lakhani, Omair; Drudge, Christopher; Craigie, Samantha; Mendell, Ari; Park-Wyllie, Laura

doi:10.1007/s13555-022-00811-0

Cited by 11 publications

(4 citation statements)

References 38 publications

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“…[1][2][3] Known differences exist regarding treatment outcomes for psoriasis patients with skin of color (SOC), with SOC patients reporting increased risk for hospitalization due to psoriasis and greater negative impact on quality of life. 4,5 Several possible explanations exist for this phenomenon. First, previous studies have suggested that dermatologists may underestimate the severity of psoriasis in patients with SOC due to differences in their cutaneous presentations compared to those in White patients.…”

Section: Introductionmentioning

confidence: 99%

“…6 For example, psoriasis plaques may be mistaken for post-inflammatory hyperpigmentation on black skin. [4][5][6] Patients with SOC may be underrepresented in clinical trials for psoriasis. 4,5,7 Furthermore, differences in socioeconomic status, access to health care, and lack of culturally competent care may contribute to worse treatment outcomes for patients of different races and ethnicities.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Patients with SOC may be underrepresented in clinical trials for psoriasis. 4,5,7 Furthermore, differences in socioeconomic status, access to health care, and lack of culturally competent care may contribute to worse treatment outcomes for patients of different races and ethnicities. 4 Psoriasis patients with SOC also report a significantly worse quality of life compared to White psoriasis patients.…”

Section: Introductionmentioning

confidence: 99%

“…4,5,7 Furthermore, differences in socioeconomic status, access to health care , and lack of culturally competent care may contribute to worse treatment outcomes for patients of different races and ethnicities. 4 Psoriasis patients with SOC also report a significantly worse quality of life compared to White psoriasis patients. 5 Thus, it is crucial to investigate possible differences in manifestations of psoriatic disease in order to optimize care for psoriasis patients with SOC.…”

Section: Introductionmentioning

confidence: 99%

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Comorbidity Burden in Psoriasis Patients With Skin of Color

Peterson,

Huang,

Lee

et al. 2023

Journal of Psoriasis and Psoriatic Arthritis

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Background Psoriasis is a chronic disease with increased risk of numerous comorbidities. Known differences exist regarding treatment outcomes for psoriasis patients with skin of color (SOC). Factors contributing to these differences are relatively unknown. Objectives This study aims to compare the comorbidity burden in SOC psoriasis patients vs White patients, as measured by the Charlson Comorbidity Index (CCI). Methods We utilized the National Ambulatory Medical Care Survey (NAMCS) to identify visits for adult psoriasis patients occurring in the years 2002-2016 and 2018. The CCI was used to objectively measure comorbidity burden. Patients were identified by race, and SOC was defined as any reported race besides White Only. A multiple linear regression was run to compare the CCI among adult psoriasis patients based on race and ethnicity, controlling for age, sex, insurance status, and geographic region. Results A total of 39, 176, 928 weighted visits were analyzed. Compared to White patients, patients with SOC did not have statistically significant differences in comorbidity burden, as measured by CCI ( P = .073 for Black/African American Only vs White Only, P = .073 for American Indian/Alaska Native Only vs White Only, P = .435 for Asian Only vs White Only, P = .403 for Native Hawaiian/Pacific Islander Only vs White Only, P = .195 for Other vs White Only). Conclusion Patients with SOC were not found to have differences in comorbidity burden compared to White patients. These results highlight that social factors such as socioeconomic status and access to health care may contribute more directly to psoriasis treatment outcomes than patient race.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comorbidity Burden in Psoriasis Patients With Skin of Color

Peterson,

Huang,

Lee

et al. 2023

Journal of Psoriasis and Psoriatic Arthritis

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Improving Diversity in a Novel Psoriasis Study

Alexis,

McMichael,

Vashi

et al. 2024

JAMA Dermatol

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ImportanceDiverse racial and ethnic representation in clinical trials has been limited, not representative of the US population, and the subject of pending US Food and Drug Administration guidance. Psoriasis presentation and disease burden can vary by skin pigmentation, race and ethnicity, and socioeconomic differences. Overall, there are limited primary data on clinical response, genetics, and quality of life in populations with psoriasis and skin of color (SoC). The Varying Skin Tones in Body and Scalp Psoriasis: Guselkumab Efficacy and Safety trial (VISIBLE) is underway and uses strategies aimed at addressing this persistent gap.ObjectiveTo assess the innovative strategies used in the VISIBLE trial to recruit and retain diverse participants in a randomized clinical trial of psoriasis in participants with SoC.Design, Setting, and ParticipantsThis was an ad hoc quality improvement assessment of participant recruitment and retention approaches used by the VISIBLE trial. VISIBLE enrolled and randomized 211 participants (mean [SD] age, 43 [13] years; 75 females [36%] and 136 males [64%]) with SoC and moderate to severe plaque psoriasis from August 2022 to March 2023 to evaluate guselkumab treatment. The self-identified race and ethnicity of the participants was: 1 American Indian/Alaska Native (0.5%), 63 Asian (29.9%), 24 Black (11.4%), 94 Hispanic/Latino (44.5%), 13 Middle Eastern (6.2%), 1 Pacific Islander/Native Hawaiian (0.5%), 12 multiracial (5.7%), and 3 of other race and/or ethnicity (1.4%). Using a combination of objective (colorimetry to determine Fitzpatrick skin type) and self-reported (race and ethnicity consistent with SoC) parameters, VISIBLE sought to broaden inclusion of participants from various backgrounds.ResultsObserved improvements were that participant enrollment occurred approximately 7 times faster than anticipated (vs historical recruitment data for psoriasis studies); 211 participants (100%) self-identified themselves as a race or ethnicity other than White; and more than 50% had skin tone in the darker half of the Fitzpatrick skin type spectrum (type IV-VI). Innovations implemented by VISIBLE were (1) assessment of the natural history of postinflammatory pigment alteration and improvements over time using combined objective colorimetry and clinician- and patient-reported outcomes; (2) evaluation of genetic and comorbidity biomarkers relevant to participants with SoC; (3) a diverse demographic-driven approach to site selection (emphasizing investigator and staff diversity and experience with populations with SoC); (4) provision of cultural competency training to enhance participant enrollment and retention; (5) collection of patient-reported outcomes data in participants’ primary language; and (6) periodic, blinded central review and feedback on investigator efficacy scoring to promote consistency and accuracy in evaluating psoriasis in participants with SoC.Conclusions and RelevanceVISIBLE is a unique study focused on addressing important knowledge and data gaps in populations of patients with psoriasis and SoC, with the goal of generating data to help improve clinical care and inform future best practices in diversity within dermatology research. The rapid study enrollment demonstrates that intentional and strategic approaches to clinical trial design and conduct can speed recruitment and bolster participation and retention of diverse populations in a dermatologic setting.Trial RegistrationClinicalTrials.gov Identifier: NCT05272150

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