Current status of plaque psoriasis diagnosis and treatment: Requirements to implement appropriate treatment

on 10月 26, 2023

October 29th is World Psoriasis Day.

Since World Psoriasis Day was established in 2004, annual events have been held worldwide to raise awareness, improve access to treatment, and promote understanding of the condition.

The theme for World Psoriasis Day 2023 is “Access for All.” It is estimated that there are approximately 400,000—500,000 patients with psoriasis in Japan*. Currently, the treatments for psoriasis are greatly improved, and holistic care research is advancing steadily. However, the disease remains comparatively unknown to the general public. The slogan reflects the goal that everyone with psoriasis will receive timely access to the correct treatment.

In conjunction with World Psoriasis Day, CareNet and Macromil CareNet surveyed 200 physicians (100 hospital and 100 clinic doctors) who are involved in the systemic treatment of plaque psoriasis.

Survey period: 2023/09/27 – 2023/09/28

Results indicated that it is important to have close communication with doctors and patients regarding quality of life (QOL). Communication should go beyond discussing symptoms to enquiring as to whether there are any daily inconveniences that the patients are facing. The patients should be helped to correctly understand the benefits and safety of systemic treatment, as well as the subsidy system for treatment costs. In addition to communication with doctors, it is necessary to have an information provision system that allows patients to access and understand accurate treatment knowledge.

(1) Our study found that 40% of plaque psoriasis patients receive “systemic treatment” in hospitals and 24% in clinics. By contrast, 18% of patients in hospitals and 15% in clinics are eligible for systemic treatment but are not receiving it, indicating that appropriate treatment is not being provided to patients who require systemic treatment.

(2) The most common reason for patients who are eligible for systemic therapy but have not received treatment is “refusal to take the drug recommended due to the high cost burden.” This occurred with 78% in hospital and 75% in clinic. Regarding safety, while doctors themselves have little concern about side effects, the percentage of patients who refuse the recommended drug owing to this concern is high at 25% in hospitals and at 45% in clinics. We surmise that the benefits of systemic treatment are not communicated well to patients.

(3) Objective indicators such as “Psoriasis Area and Severity Index (PASI)” and “Body Surface Area (BSA)” are mainly used to determine treatment strategies for psoriasis. Only 30% of hospital doctors and 20% of clinic doctors use the impact on patients’ quality of life (DLQI).

(4) Regarding “patient complaints” when considering the implementation of systemic therapy, “severity of symptoms (total)” was found to be the reason in 85% of hospitals and 89% of clinics, and “impact on daily life (total)” was found to be the reason in 70% of hospitals and 68% of clinics. During daily medical treatment, patients not only complain about their symptoms but also communicate with their doctors about the effects on their daily lives, which can lead to more appropriate treatment choices.

(5) Regarding the percentage of prescriptions for drugs used in systemic therapy, “biological products” are the most commonly prescribed in hospitals at an average of 42%, followed by apremilast (otezla) at 37%. At clinics, oral medications are the most common, with 58% choosing apremilast (otezla) and 13% using biological products. For patients receiving systemic treatment, it is assumed that at the point where their GP (General Practioner) can no longer control their condition with oral medication, biological agents will be introduced at the hospital by HP(Hospital).

The 200 doctors involved in the systemic treatment of patients with plaque psoriasis who responded to the survey revealed that in the past three months, they had treated an average of 49.7 patients in hospitals and 26.8 patients in clinics.

Among them, 40% of hospital patients and 24% of clinic patients received “systemic treatment”. Furthermore, 18% of patients in hospitals and 15% in clinics are eligible for systemic treatment but are not receiving it, indicating that appropriate treatment is not being provided to patients who require systemic treatment.

[Table 1]

In response to the question, “Please tell me what indicators you usually use when deciding on a treatment plan or changing treatment details for patients with plaque psoriasis,” it was found that “PASI” was the most common answer, at 77% for hospital doctors and 66% for clinic doctors. The second most common treatment is “BSA” at 50% of hospitals and 47% of clinics.

Objective indicators such as “PASI” and “BSA” are mainly used to determine treatment strategies for psoriasis. Only 30% of hospital doctors and 20% of clinic doctors use the impact on patients’ quality of life (DLQI).

[Table 2]

In response to the question, “For what specific complaints from patients with plaque psoriasis would you consider implementing ‘systemic therapy?’” it was found that 85% of hospital doctors and 89% of clinic doctors answered “severity of symptoms (total).”
Regarding specific complaints, “range of skin symptoms” had the highest response rate, followed by “degree of itching.” The “degree of itching” found was higher in the clinics (53%) than that found in the hospitals (43%).
It was also found that 70% of doctors in hospitals and 68% of doctors in clinics responded to “Impact on daily life (total).” Approximately 40% of doctors answered that they consider “feelings,” “going out/personal relationships,” and “ability to concentrate” when considering implementing systemic therapy.
During daily medical treatment, patients not only complain about their symptoms but also communicate with their doctors about the effects on their daily lives, which can lead to more appropriate treatment choices.

[Table 3]

We asked physicians treating patients with plaque psoriasis who are candidates for systemic therapy but have not yet undergone systemic therapy, the following question: “Please tell us why systemic therapy has not been performed.” The most common response was “refusing the drug recommended because of the high cost,” at 78% in hospitals and 75 % in clinics. Regarding safety, only 10% of hospitals and 15% of clinics responded that “doctors themselves are concerned about side effects.” However, 25% of hospitals and 45% of clinics said that “patients refuse recommended drugs due to concerns about side effects.” We surmise that the benefits of systemic treatment are not communicated well to patients.

[Table 4]

Regarding the percentage of prescriptions for drugs used in systemic therapy, “biological products” are the most commonly prescribed in hospitals at an average of 42%, followed by apremilast (Otezla) at 37%. At clinics, oral medications are the most common, with 58% choosing apremilast (Otezla) and 13% using biological products.

Given that “biological products” are introduced at approved facilities, for patients who receive systemic treatment, it is assumed that at the point that their GP can no longer control their condition with oral medications, biological agents will be introduced at the hospital by HP.

The prescription rate for systemic therapy in the future is expected to be similar to the current trend. However, it is expected that “biological products” and Deucravacitinib (Sotix) will increase slightly, and Apremilast (Otezla) will decrease.

[Table 5]