Unmet Needs in the Management of Moderate-to-Severe Psoriasis in Spain: A Multidimensional Evaluation
Keywords:Psoriasis, moderate-to-severe, biologics, unmet needs, discrete choice
Psoriasis is a chronic, systemic inflammatory disease that affects the skin, with a high impact on patients’ quality of life. The aim of this study was to identify and determine the relative importance of unmet needs in the management of moderate-to-severe psoriasis in Spain, from a multi-stakeholder perspective. A mixed method-approach was used to collect information, design a questionnaire and a discrete-choice exercise, and elicit the unmet needs through a multidisciplinary committee composed of 12 experts. A total of 65 unmet needs were identified and categorized into 4 areas: clinical, patient-related, decision-making process, and social. Decision-making process unmet needs were perceived as the most pressing ones, followed by social, clinical and patient-related. Individually, the need to incorporate outcomes that are important to the patients and to have treatments that achieve total clearance with a rapid onset of action and long-term persistence were the most important unmet needs.
Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80: 1029-1072.
World Health Organization. Global report on psoriasis. WHO (Internet) 2016 (cited 2021 May 31). Available from: https://apps.who.int/iris/handle/10665/204417.
Burgos-Pol R, Martínez-Sesmero JM, Ventura-Cerdá JM, Elías I, Caloto MT, Casado MÁ. The cost of psoriasis and psoriatic arthritis in 5 European countries: a systematic review. Actas Dermosifiliogr (Engl Ed) 2016; 107: 577-590.
Carrascosa J, Pujol R, Daudén E, Hernanz-Hermosa J, Bordas X, Smandia J, et al. A prospective evaluation of the cost of psoriasis in Spain (EPIDERMA project: Phase II). J Eur Acad Dermatol Venereol 2006; 20: 840-845.
Reid C, Griffiths CEM. Psoriasis and treatment: past, present and future aspects. Acta Derm Venereol 2020; 100: adv00032.
Association of Psoriasis Patients, Psoriatic Arthritis Patients and their Relatives. Survey "NEXT" on current needs and future expectations in psoriasis in Spain: report of results. Acción Psoriasis 2020. [cited 2021 Apr 29] Available from: https://www.accionpsoriasis.org/recursos/publicaciones/otras-publicaciones.html.
Kerkhof PCM, Reich K, Kavanaugh A, Bachelez H, Barker J, Girolomoni G, et al. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey. J Eur Acad Dermatol Venereol 2015; 29: 2002-2010.
Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2021.[cited 2021 Apr 20] Available from: https: //www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011535.pub4/full.
Armstrong AW, Soliman AM, Betts KA, Wang Y, Gao Y, Puig L, et al. Comparative efficacy and relative ranking of biologics and oral therapies for moderate-to-severe plaque psoriasis: a network meta-analysis. Dermatol Ther (Heidelb) 2021; 11: 885-905.
Egeberg A, Andersen YMF, Halling-Overgaard A-S, Alignahi F, Thyssen JP, Burge R, et al. Systematic review on rapidity of onset of action for interleukin-17 and interleukin-23 inhibitors for psoriasis. J Eur Acad Dermatol Venereol 2020; 34: 39-46.
Lin P-T, Wang S-H, Chi C-C. Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence. Sci Rep 2018; 8: 16068.
Mason KJ, Barker JNWN, Smith CH, Hampton PJ, Lunt M, McElhone K, et al. Comparison of drug discontinuation, effectiveness, and safety between clinical trial eligible and ineligible patients in BADBIR. JAMA Dermatol 2018; 154: 581-588.
Puig L, Carrascosa J-M, Daudén E, Sulleiro S, Guisado C. Drug survival of conventional systemic and biologic therapies for moderate-to-severe psoriasis in clinical practice in Spain: prospective results from the SAHARA study. J Dermatolog Treat 2020; 31: 344-351.
Lebwohl MG, Bachelez H, Barker J, Girolomoni G, Kavanaugh A, Langley RG, et al. Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol 2014; 70: 871-881.
Christophers E, Griffiths CEM, Gaitanis G, van de Kerkhof P. The unmet treatment need for moderate to severe psoriasis: results of a survey and chart review. J Eur Acad Dermatol Venereol 2006; 20: 921-925.
Association of Psoriasis Patients, Psoriatic Arthritis Patients and their Relatives. IMPAS Survey Summary - Impact of Psoriasis and Associated Comorbidities. Acción Psoriasis (Internet) 2016. [cited 2021 May 5] Available from: https: //issuu.com/accionpsoriasis/docs/anexo_encuesta_impas_-_d__a_mundial.
González-Parra S, Daudén E. Psoriasis and depression: the role of inflammation. Actas Dermosifiliogr 2019; 110: 12-19.
Association of Psoriasis Patients, Psoriatic Arthritis Patients and their Relatives. Psoriasis "NEXT" survey: report of results. Acción Psoriasis 201. [cited 2021 May 5] Available from: https: //issuu.com/accionpsoriasis/docs/next.
Jaworecka K, Muda-Urban J, Rzepko M, Reich A. Molecular aspects of pruritus pathogenesis in Psoriasis. Int J Mol Sci 2021; 22: 858.
Boehncke W-H, Brembilla NC. Unmet needs in the field of psoriasis: pathogenesis and treatment. Clin Rev Allergy Immunol 2018; 55: 295-311.
General Council of Pharmaceutical Associations. Drug Database - Laboratory Selling Price (PVL). BotPlus 2020. [cited 2021 Apr 25] Available from: https://botplusweb.portalfarma.com/.
Epstein D, Espín J. Evaluation of new medicines in Spain and comparison with other European countries. Gac Sanit 2020; 34: 133-140.
Norlin JM, Althin R, Schmitt-Egenolf M, Persson U. An outcome-based payment model for biologic agents in psoriasis: a report from the Swedish Institute for Health Economics. IHE (Internet) 2018. [Cited 2021 Mar 3] Available from: https://ihe.se/wp-content/uploads/2018/07/IHE-Report-2018_2_.pdf.
Feldman, S, Goffe, B, Rice, G, Mitchell, M. The challenge of managing psoriasis: unmet medical needs and stakeholder perspectives. Am Health Drug Benefits 2016. [cited 2017 May 29] Available from: http://www.ahdbonline.com/components/com_mams/dl.php?dlid=1615.
Kromer C, Schaarschmidt M-L, Schmieder A, Herr R, Goerdt S, Peitsch WK. Patient preferences for treatment of psoriasis with biologicals: a discrete choice experiment. PLoS ONE 2015; 10: e0129120.
Ashcroft DM, Seston E, Griffiths CEM. Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists. Br J Dermatol 2006; 155: 1236-1241.
Puig, L, Dobao P de la C, Linares M, Suárez J, Pastor MV, Vidal A, et al. Psoriasis expert report: opinion of Spanish dermatologists on the management of moderate-to-severe psoriasis with biologic agents in adult patients. Actas Dermosifiliogr 2013; 104: 400-408.
Minds. PAPRIKA method. 1000minds 2021. [cited 2021 Jul 14] Available from: https: //www.1000minds.com/about/paprika.
minds. Decision-making and conjoint analysis software. 1000minds 2019. [cited 2019 Dec 19] Available from: https://www.1000minds.com/.
Feldman SR, Regnier SA, Chirilov A, Hey F, Gilloteau I, Cella D. Patient-reported outcomes are important elements of psoriasis treatment decision making: a discrete choice experiment survey of dermatologists in the United States. J Am Acad Dermatol 2019; 80: 1650-1657.
Tan J, Stacey D, Fung K, Barankin B, Bissonnette R, Gulliver W, et al. Treatment decision needs of psoriasis patients: cross-sectional survey. J Cutan Med Surg 2010; 14: 233-239.
Damiani G, Bragazzi NL, Garbarino S, Chattu VK, Shapiro CM, Pacifico A, et al. Psoriatic and psoriatic arthritis patients with and without jet-lag: does it matter for disease severity scores? Insights and implications from a pilot, prospective study. Chronobiol Int 2019; 36: 1733-1740.
Damiani G, Watad A, Bridgewood C, Pigatto PDM, Pacifico A, Malagoli P, et al. The impact of ramadan fasting on the reduction of PASI score, in moderate-to-severe psoriatic patients: a real-life multicenter study. Nutrients 2019; 11: 277.
Kragballe K, van de Kerkhof PC, Gordon KB. Unmet needs in the treatment of psoriasis. Eur J Dermatol 2014; 24: 523-532.
Carretero G, Moreno D, González Domínguez A, Trigos D, Ledesma A, Sarquella E, et al. Multidisciplinary approach to psoriasis in the Spanish National Health System: a social return on investment study. Glob Reg Health Technol Assess 2020; 7: 50-56.
Conic RR, Damiani G, Schrom KP, Ramser AE, Zheng C, Xu R, et al. Psoriasis and psoriatic arthritis cardiovascular disease endotypes identified by red blood cell distribution width and mean platelet volume. J Clin Med 2020; 9: 186.
Damiani G, Pacifico A, Linder DM, Pigatto PDM, Conic R, Grada A, et al. Nanodermatology-based solutions for psoriasis: state-of-the art and future prospects. Dermatol Ther 2019; 32: e13113.
Bolt T, Kobayashi H, Mahlich J. Patient and physician preferences for therapy characteristics for psoriasis: a discrete choice experiment in Japan. Pharmacoecon Open 2019; 3: 255-264.
How to Cite
Copyright (c) 2022 Néboa Zozaya, Renata Villoro, Fernando Abdalla, Santiago Alfonso Zamora, Jesús Balea Filgueiras, José Manuel Carrascosa Carrillo, Olga Delgado Sánchez, Francisco Dolz Sinisterra, Antonio García-Ruiz, Pedro Herranz Pinto, Antonio Manfredi, José Martínez Olmos, Paloma Morales de los Ríos Luna, Lluis Puig Sanz, Sandra Ros, Álvaro Hidalgo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.