Therapeutic Inertia in the Management of Psoriasis: A Quantitative Survey Among Indian Dermatologists and Patients

Abstract

Purpose

The primary objective of the study was to understand the therapeutic inertia in treatment and management of plaque psoriasis among dermatologists, along with determining the preferred treatment choices for management of plaque psoriasis; it also included the resulting treatment satisfaction among patients. The secondary objective was to identify the gaps in terms of knowledge and attitude among dermatologists and the expectations of patients.

Patients and Methods

A multicentre, cross-sectional quantitative survey was conducted among dermatologists and patients with moderate to severe plaque psoriasis across India. The interviews were conducted either face to face or via telephone between September and November 2020, using structured and validated questionnaires based on specific themes. The data obtained were statistically analysed, wherever applicable.

Results

Overall, 207 adult patients with moderate-to-severe plaque psoriasis and 303 dermatologists were interviewed. Post experiencing symptoms, 44% of the patients visited general physicians for treatment and there was an average 7.8-month delay by the patients to consult a dermatologist. Approximately one-fourth of patients used home remedies before seeking medical help. One-third of dermatologists used the Psoriasis Area and Severity Index (PASI) for assessing the disease severity. Majority of dermatologists preferred combination therapy for their patients. The lack of quick resolution and side effects were the major reasons for changing the treatment. Overall, only 35% of the patients complied to current treatment. Satisfaction with existing forms of therapies was highest for mild plaque psoriasis (62%) as confirmed by dermatologists, while 52% of the overall patients were satisfied with their therapy. Majority of the patients (64%) affirmed living with plaque psoriasis impacted their lives.

Conclusion

This first-of-its-kind survey in India highlighted the gaps in terms of the disease journey between dermatologists and patients. The survey emphasises the need for shared decision-making and may benefit dermatologists in suggestive modifications of the treatment algorithm and disease management in clinical settings.

Keywords:

• therapeutic inertia
• psoriasis
• adherence
• treatment expectations
• treatment goals
• diagnosis

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author.

Acknowledgments

We would like to acknowledge Rubina Farooqui, Akshay Halepaty and Anusharth Mulay from IQVIA Primary intelligence team for their help in conducting the survey, and Mrigna Malhotra, Bushra Nabi and Yukti Singh from IQVIA, India for their medical writing and editing support. We would like to acknowledge Dr Akshay Desai, Franchise Medical Head, Novartis Healthcare Pvt Ltd India for his editorial support.The medical writing and editorial support were funded by Novartis Healthcare Pvt Ltd.

A part of the study has been presented earlier: Mauiderm Poster (patient findings), EADV Spring symposium Poster (dermatologist’s perspective), IFPA Posters: Zonal and gender trends, EADV Spring Symposium Poster: Biologic usage specific trends.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Pallavi Kawatra is an employee of Novartis Healthcare Pvt Ltd, India. Dr Murlidhar Rajagopalan reports personal fees from Novartis, during the conduct of the study; is a speaker and advisor for Novartis,Sanofi, Janssen, Pfizer, Sun Pharma, Gracewell, Dr Reddy's Labs, Eli Lilly, Zydus Cadila, Merck Sharpe and Dohme and has received honoraria for lectures. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research has been funded by Novartis Healthcare Pvt Ltd.