A study published in Dermatology aimed to characterize patients with vs without psoriasis in challenging-to-treat areas seen in routine US clinical practices as they noted real-world studies are limited.
The retrospective observational study assessed patient demographics, clinical characteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) at registry enrollment. These characteristics were then compared between patients with vs patients without challenging-to-treat areas. Adult patients with psoriasis who were enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 and who initiated a biologic therapy were included. Nonparametric Kruskal-Wallis tests and χ2 or Fisher exact tests were used to analyze continuous variables and categorical variables, respectively. Additionally, the study used generalized linear regression models to estimate differences in disease activity and patient-reported outcomes between patients with vs without each challenging-to-treat area.
The results demonstrate that of the 2042 patients with psoriasis, 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, and 10.9% had palmoplantar psoriasis. Further, 26.2% had a combination of 2 or more challenging-to-treat areas and PsA, while only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients within the challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62-58.40] vs 54.35 [53.99-54.72]; nail, 56.42 [56.02-56.81] vs 55.59 [55.20-55.97]; palmoplantar, 60.22 [59.86-60.59] vs 55.15 [54.79-55.54]) and lower EQ VAS (scalp, 68.12 [67.78-68.48] vs 69.46 [69.12-69.81]; nail, 66.21 [65.89-66.55] vs 69.48 [69.14-69.83]; palmoplantar, 66.21 [66.07-66.75] vs 69.29 [68.94-69.94]) scores than patients without challenging anatomical locations. Particularly, patients with nail or palmoplantar psoriasis reported higher scores for pain, fatigue, and DLQI, and more patients with scalp or palmoplantar psoriasis reported work impairment than those without.
The authors noted that two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-to-treat area. Based on the study data, they concluded that “patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients' quality of life.” —Jessica Garlewicz
Callis Duffin K, Mason MA, Gordon K, et al. Characterization of patients with psoriasis in challenging-to-treat body areas in the Corrona Psoriasis Registry. Dermatology. 2021;237(1):46-55. doi:10.1159/000504841