Original article
Patient perspectives in the management of psoriasis: Results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey

Presented as an e-poster at the 22nd Annual Meeting of the European Academy of Dermatology and Venereology, Istanbul, Turkey, October 2-6, 2013.
https://doi.org/10.1016/j.jaad.2013.12.018Get rights and content

Background

Available psoriasis surveys offer valuable information about psoriasis and psoriatic arthritis (PsA), but are limited by methodology or enrollment requirements.

Objective

To further the understanding of the unmet needs of psoriasis and PsA patients.

Methods

This was a large, multinational, population-based survey of psoriasis and/or PsA patients in North America and Europe. Patients were selected by list-assisted random digit dialing and did not have to currently be under the care of a health care provider, a patient organization member, or receiving treatment; 139,948 households were screened and 3426 patients completed the survey.

Results

The prevalence of psoriasis/PsA ranged from 1.4% to 3.3%; 79% had psoriasis alone and 21% had PsA. When rating disease severity at its worst, 27% (psoriasis) and 53% (PsA ± psoriasis) of patients rated it as severe. Psoriasis patients indicated that their most bothersome signs or symptoms were itching (43%), scales (23%), and flaking (20%). Of psoriasis patients, 45% had not seen a physician in a year; >80% of psoriasis patients with ≥4 palms body surface area and 59% of PsA patients were receiving no treatment or topical treatment only. Of patients who had received oral or biologic therapy, 57% and 45%, respectively, discontinued therapy, most often for safety/tolerability reasons and a lack/loss of efficacy.

Limitations

The survey lacked a control group, did not account for ethnic and health care system differences across countries, and was limited by factors associated with any patient survey, including accurate recall and interpretation of questions.

Conclusions

Several identified unmet needs warrant additional attention and action, including improved severity assessment, PsA screening, patient awareness, and treatment options.

Introduction

Published estimates of the worldwide prevalence of psoriasis range from approximately 1% to 3%.1, 2, 3, 4 Although information is available on the impact of psoriasis on patients’ lives5, 6, 7, 8, 9, 10 and treatment patterns,3, 11, 12 the current evidence is variable and lacking in many areas, and numerous unmet needs remain, including underdiagnosis2, 13 and suboptimal treatment.3, 11, 12, 14

Results of patient surveys have appeared in the medical literature since 1968 (Appendices A and B; available online at www.jaad.org).11, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 While available surveys offer some insight into the disease burden and treatment of psoriasis, some limitations persist. Generally, these surveys are not population-based, and many were conducted within specific geographic regions, with variable methods and populations.25, 27, 33, 34, 41, 42 Surveys are often limited to patients who are currently under the care of a health care provider (HCP) or are members of a psoriasis patient association.17, 34, 36, 41, 42 In addition, limited information has been gathered from patients and physicians, particularly regarding factors that influence motivation for seeking medical care and taking and adhering to therapy.

To further our understanding of how psoriasis affects patients’ lives and the unmet treatment needs from the perspectives of both patients and physicians, a population-based survey of 3426 patients and 781 physicians in North America and Europe was conducted. The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey is the first multinational, large-scale probability survey of psoriasis and psoriatic arthritis (PsA) based on national samplings of households in the United States, Canada, France, Germany, Italy, Spain, and United Kingdom. It focuses on the diagnosis and impact of the various manifestations of psoriasis and PsA on health-related quality of life (QOL), physician–patient relationships, and unmet treatment needs. The survey also explores patients’ perceptions of and satisfaction with medical care and current therapies; concerns about the safety, tolerability, and convenience of current therapies; and the desire for new therapies. Developed with patient, advocacy group, and physician input, the MAPP survey includes patients with psoriasis and PsA, patients not currently seeing an HCP, and HCPs caring for patients with psoriasis. This unique survey aims to provide a true reflection of psoriasis and PsA severity and impact in the community. We provide an overview of the methodology and patient survey results.

Section snippets

Survey design

The MAPP survey, conducted by Abt SRBI, Inc (New York, NY) between June 2012 and August 2012, followed a confirmed methodology used for other chronic diseases43, 44, 45 and the American Association for Public Opinion Research guidelines for developing and conducting surveys.46 Institutional review board approval was granted for data collection in the United States (Abt SRBI 5454), and the other countries abided by standards and ethical practices according to their codes or guidelines.

MAPP was a

Results

The household prevalence of psoriasis and/or PsA ranged from 2.9% in France to 6.5% in Canada; the extrapolated population prevalence ranged from 1.4% in Spain to 3.3% in Canada (Table II). Of the 3426 patients surveyed, 79% indicated a current diagnosis of psoriasis alone and 21% had PsA with or without psoriasis. The mean age was 54.8 years, and the majority of patients were female (59%) and overweight or obese (64%; Table III).

Discussion

The MAPP survey is the largest multinational probability survey of patients with psoriasis and PsA. It was conducted without the bias of a specific clinic or geographic region and was not limited by current medical care or enrollment in a patient association. The MAPP survey included validated QOL assessments (ie, DLQI and HAQ-8) and an assessment of qualitative factors related to medical care to seek reasons why patients find their disease and treatment burdensome. This report focuses on the

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  • Cited by (0)

    Survey sponsored by Celgene Corporation.

    The authors received editorial support in the preparation of the manuscript from Peloton Advantage, LLC, and Jennifer Schwinn, RPh, funded by Celgene Corporation. Dr Lebwohl has served as an investigator for Amgen, Celgene Corporation, Coronado Biosciences, Eli Lilly and Company, Janssen Biotech, Inc, LEO Pharma, GlaxoSmithKline, and Ranbaxy Inc, and as a consultant for Abbott Laboratories, Amgen, Anacor Pharmaceuticals, Inc, BioLineRx, Ltd, Celgene Corporation, DermiPsor Ltd, Eli Lilly and Company, Galderma, Janssen Biotech, Inc, LEO Pharma, Maruho Co, Ltd, Meda Pharmaceuticals, Novartis Pharmaceuticals Corporation, Pfizer Inc, and Valeant Pharmaceuticals. Dr Bachelez has served on the advisory board of and as a consultant and speaker for AbbVie Pharmaceuticals, Amgen, Celgene Corporation, Eli Lilly and Company, Janssen Pharmaceuticals, LEO Pharma, Novartis Pharmaceuticals Corporation, and Pfizer Inc, and on the advisory board of Boehringer Ingelheim. Dr Barker has no conflicts of interest to declare. Dr Girolomoni has served as an investigator for Celgene Corporation, MSD, Novartis Pharmaceuticals Corporation, and Pfizer Inc; on the advisory board of Almirall and Otsuka Pharmaceutical Co, Ltd; and on the advisory board of and as a speaker for AbbVie Pharmaceuticals, Janssen Pharmaceuticals, LEO Pharma, MSD, Novartis Pharmaceuticals Corporation, and Pfizer Inc. Dr Kavanaugh has served as an investigator for AbbVie Pharmaceuticals, Amgen, Bristol-Myers Squibb, Celgene Corporation, Janssen Pharmaceuticals, and UCB, Inc. Dr Langley has served on the advisory board of and as an investigator and speaker for AbbVie Pharmaceuticals, Amgen, Celgene Corporation, Centocor, Pfizer Inc, Novartis Pharmaceuticals, and LEO Pharma. Dr Paul has served as a consultant for AbbVie Pharmaceuticals, Amgen, Celgene Corporation, Eli Lilly and Company, Janssen Pharmaceuticals, LEO Pharma, Novartis Pharmaceuticals Corporation, Pfizer Inc, and Pierre Fabre. Dr Puig has served as an investigator for Amgen, Janssen Pharmaceuticals, LEO Pharma, Eli Lilly and Company, MSD, Pfizer Inc, and VBL Therapeutics; as a consultant for Amgen, Boehringer Ingelheim, Merck-Serono, and VBL Therapeutics; and as a consultant and speaker for AbbVie Pharmaceuticals, Celgene Corporation, Janssen Pharmaceuticals, LEO Pharma, MSD, and Pfizer Inc. Dr Reich has served as an investigator, advisory board member, speaker, and/or consultant for AbbVie Pharmaceuticals, Amgen, Biogen-Idec, Celgene Corporation, Centocor, Covagen, Eli Lilly and Company, Forward Pharma, GlaxoSmithKline, Janssen-Cilag, LEO Pharma, Medac Pharma, MSD, Novartis Pharmaceuticals Corporation, Ocean Pharma, Pfizer Inc, Takeda Pharmaceutical Company, and Vertex Pharmaceuticals. Dr van de Kerkhof has served as an investigator for Abbott Laboratories, Amgen, Basilea, Janssen-Cilag, Pfizer Inc, and Philips, and as a consultant for Abbott Laboratories, Almirall, Amgen, Celgene Corporation, Centocor, Eli Lilly and Company, Galderma, Janssen-Cilag, LEO Pharma, Pfizer Inc, and Philips.

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