Evaluating prevalence and consequence of residual disease in individuals with psoriasis receiving apremilast treatment: results from a US patient survey

Figures & data

Figure 1. Study sample attrition flow chart.^aRespondents could have failed the screen for multiple reasons.

Table 1. Participants’ sociodemographics and clinical characteristics.

Parameter	Apremilast users (N = 344)
Age, mean (SD), y	44.9 (12.7)
Sex, n (%)
Female	225 (65.4)
Male	118 (34.3)
Prefer not to answer	1 (0.3)
Race, n (%)^a
White	249 (72.4)
Black	49 (14.2)
American Indian or Alaska Native	9 (2.6)
Asian	4 (1.2)
Other	4 (1.2)
Prefer not to answer	34 (9.9)
Hispanic, Latino, or Spanish origin, n (%)
Yes	46 (13.4)
No	293 (85.2)
Don’t know/prefer not to answer	5 (1.5)
Health insurance type, n (%)^a
Medicare/Medicaid	63 (18.3)
Private health insurance	282 (82.0)
Military/veterans coverage	12 (3.5)
Uninsured	1 (0.3)
Disease duration, mean (SD), y	15.0 (11.0)
Treatment duration, mean (SD), y	1.6 (3.7)
Psoriasis severity based on 6-point scale, n (%)
None	75 (21.8)
Very mild	84 (24.4)
Mild	71 (20.6)
Moderate	83 (24.1)
Severe	24 (7.0)
Very severe	7 (2.0)
Psoriasis severity based on BSA, n (%)
Mild (<3% BSA)	184 (53.5)
Moderate (3%–10% BSA)	149 (43.3)
Severe (>10% BSA)	11 (3.2)
Flare-ups, past 3 mo, mean (SD), n	2.8 (5.8)

^aParticipants could select more than one response option.

BSA: body surface area; SD: standard deviation.

Table 2. Factors associated with residual disease among participants treated with apremilast.^a

Parameter	Stepwise logistic regression
	OR (95% CI)	P-value
Race
White	Reference
Black	4.5 (1.6–12.2)	.015
Asian or Pacific Islander^b	1.7 (0.4–7.3)
Other	2.3 (0.2–26.5)
Prefer not to answer	4.0 (1.3–12.0)
Treatment duration
<1 year	Reference
≥1 year	16.5 (7.9–34.4)	<.001
No. of flare-ups
0–1	Reference
≥2	10.0 (5.0–20.1)	<.001
No. of body regions affected^c
1–3	Reference
≥4	8.6 (3.8–19.8)	<.001

^a Treated with apremilast at time of survey participation.

^b Includes Asian, American Indian/Alaska Native, Native Hawaiian/other Pacific Islander.

^c Includes scalp, face, neck, ears, hands, fingers, fingernails, arms, elbows, chest, abdomen, back, shoulders, genital area, buttocks, thighs, knees, lower legs, ankles, toes, and toenails.

CI: confidence interval; OR: odds ratio.

Table 3. Humanistic burden in participants treated with apremilast^a by residual disease classification.

Parameter	Apremilast users
	All N = 344	Residual disease
		Yes n = 174	No n = 170	P-value
DLQI score, mean (SD)
Global (range: 0–30)	8.1 (7.2)	11.8 (7.3)	4.4 (4.8)	<.001
Symptoms and feelings (range: 0–6)	2.4 (1.7)	3.3 (1.4)	1.4 (1.3)	<.001
Daily activities (range: 0–6)	1.8 (1.7)	2.5 (1.7)	1.0 (1.1)	<.001
Leisure (range: 0–6)	1.7 (1.8)	2.2 (1.8)	1.2 (1.5)	<.001
Work and school performance (range: 0–3)	0.7 (1.1)	1.1 (1.3)	0.2 (0.7)	<.001
Personal relationships (range: 0–6)	1.2 (1.7)	1.8 (1.9)	0.5 (1.0)	<.001
Treatment (range: 0–3)	0.5 (0.8)	0.9 (0.9)	0.2 (0.6)	<.001
Anxiety and depression related to psoriasis, n (%)
Anxiety
Yes	241 (70.1)	156 (89.7)	85 (50.0)	<.001
No	103 (29.9)	18 (10.3)	85 (50.0)
Anxiety severity
Very anxious	37 (10.8)	29 (16.7)	8 (4.7)	<.001
Anxious	51 (14.8)	44 (25.3)	7 (4.1)
Somewhat anxious	69 (20.1)	40 (23.0)	29 (17.1)
A little anxious	84 (24.4)	43 (24.7)	41 (24.1)
Not at all anxious	103 (29.9)	18 (10.3)	85 (50.0)
Anxiety frequency^b	n = 241	n = 156	n = 85
Nearly every day	26 (10.8)	20 (12.8)	6 (7.1)	.001
More than half the days	55 (22.8)	39 (25.0)	16 (18.8)
Several days	134 (55.6)	89 (57.1)	45 (52.9)
Not at all	26 (10.8)	8 (5.1)	18 (21.2)
Depression
Yes	160 (46.5)	120 (69.0)	40 (23.5)	<.001
No	184 (53.5)	54 (31.0)	130 (76.5)
Depression severity
Very depressed	11 (3.2)	8 (4.6)	3 (1.8)	<.001
Depressed	36 (10.5)	32 (18.4)	4 (2.4)
Somewhat depressed	40 (11.6)	32 (18.4)	8 (4.7)
A little depressed	73 (21.2)	48 (27.6)	25 (14.7)
Not at all depressed	184 (53.5)	54 (31.0)	130 (76.5)
Depression frequency^c	n = 160	n = 120	n = 40
Nearly every day	14 (8.7)	14 (11.6)	0 (0.0)	<.001
More than half the days	30 (18.8)	26 (21.7)	4 (10.0)
Several days	100 (62.5)	74 (61.7)	26 (65.0)
Not at all	16 (10.0)	6 (5.0)	10 (25.0)
Anxiety reduction^d
No, definitely not	26 (7.6)	16 (9.2)	10 (5.9)	.123
Probably not	41 (11.9)	22 (12.6)	19 (11.2)
Neither yes nor no	101 (29.4)	45 (25.9)	56 (32.9)
Probably yes	115 (33.4)	66 (37.9)	49 (28.8)
Yes, definitely	61 (17.7)	25 (14.4)	36 (21.2)
Depression reduction^d
No, definitely not	20 (5.8)	13 (7.5)	7 (4.1)	.409
Probably not	44 (12.8)	22 (12.6)	22 (12.9)
Neither yes nor no	130 (37.8)	61 (35.1)	69 (40.6)
Probably yes	95 (27.6)	53 (30.5)	42 (24.7)
Yes, definitely	55 (16.0)	25 (14.4)	30 (17.6)
WPAI-PsO
People working, n (%)
Yes	206 (59.9)	121 (69.5)	85 (50.0)	<.001
No	138 (40.1)	53 (30.5)	85 (50.0)
Absenteeism (WPAI-PsO–based percentage)	n = 190	n = 115	n = 75
Mean (SD)	5.3 (13.7)	8.6 (16.8)	0.3 (1.4)	<.001
Presenteeism	n = 189	n = 114	n = 75
Mean (SD)	21.9 (22.1)	29.1 (23.1)	10.8 (14.9)	<.001
Activity Impairment	n = 344	n = 174	n = 170
Mean (SD)	26.6 (24.4)	38.1 (25.3)	14.8 (16.7)	<.001
Total work productivity impairment	n = 189	n = 114	n = 75
Mean (SD)	24.1 (24.8)	32.6 (26.2)	11.0 (15.0)	<.001

^a Treated with apremilast at time of survey participation.

^b Among patients rating their anxiety severity as very anxious, anxious, somewhat anxious, a little anxious.

^c Among patients rating their depression severity as very depressed, depressed, somewhat depressed, a little depressed.

^d Since start of current psoriasis treatment.

DLQI: Dermatology Life Quality Index; SD: standard deviation; WPAI-PsO: Work Productivity and Activity Impairment-Psoriasis.

Table 4. Comorbidities in participants treated with apremilast^a by residual disease classification.

Comorbidity	Apremilast users, n (%)^b
	All N = 344	Residual disease
		Yes n = 174	No n = 170	P-value
Anxiety	75 (21.8)	45 (25.9)	30 (17.6)	.065
Cancer/malignancy	7 (2.0)	4 (2.3)	3 (1.8)	>.999
Cardiovascular disease^c	14 (4.1)	9 (5.2)	5 (2.9)	.415
Cerebrovascular disease^d	6 (1.7)	2 (1.1)	4 (2.4)	.444
Depression	60 (17.4)	37 (21.3)	23 (13.5)	.059
Diabetes, type 1	12 (3.5)	6 (3.4)	6 (3.5)	.967
Diabetes, type 2	35 (10.2)	21 (12.1)	14 (8.2)	.240
High blood pressure (hypertension)	76 (22.1)	46 (26.4)	30 (17.6)	.049
High cholesterol	82 (23.8)	39 (22.4)	43 (25.3)	.531
Inflammatory bowel disease^e	12 (3.5)	5 (2.9)	7 (4.1)	.570
Metabolic syndrome	3 (0.9)	2 (1.1)	1 (0.6)	>.999
Obesity	62 (18.0)	38 (21.8)	24 (14.1)	.062
Peripheral vascular disease	3 (0.9)	2 (1.1)	1 (0.6)	>.999
Psoriatic arthritis	56 (16.3)	44 (25.3)	12 (7.1)	<.001
Not applicable^f	116 (33.7)	55 (31.6)	61 (35.9)	.402

^a Participants could report ≥1 comorbidity.

^b Participants treated with apremilast at time of survey.

^c Heart attack, congestive heart failure, cardiomyopathy.

^d Stenosis, thrombosis, embolism, hemorrhage, stroke.

^e Crohn’s disease or ulcerative colitis.

^f None of the comorbidities are listed in table. Survey participants were asked, “Which of the following conditions have you been diagnosed with other than psoriasis? Please select all that apply.”

Table 5. HCRU in participants treated with apremilast^a by residual disease classification.

Parameter	No. of visits/admissions, mean (SD)^b
	All N = 344	Residual disease
		Yes n = 174	No n = 170	P-value
Psoriasis-related HCRU
Physician’s office visits	1.4 (2.2)	2.1 (2.8)	0.8 (0.8)	<.001
Office-based tests/procedures	0.6 (1.0)	0.9 (1.3)	0.2 (0.5)	<.001
Office-based phototherapy sessions	0.2 (0.9)	0.4 (1.2)	0.0 (0.3)	.0004
ER or urgent care clinic	0.2 (0.7)	0.3 (1.1)	0.0 (0.0)	.0002
Hospital admissions	0.1 (0.5)	0.2 (0.7)	0.0 (0.0)	.001
All-cause HCRU
Physician office visits	1.4 (1.9)	1.6 (1.7)	1.2 (2.1)	.058
Office-based tests/procedures	0.8 (1.3)	1.0 (1.5)	0.6 (1.1)	.0009
Office-based phototherapy sessions	0.1 (0.6)	0.1 (0.7)	0.0 (0.1)	.035
ER or urgent care clinic	0.7 (0.5)	0.2 (0.6)	0.1 (0.4)	.108
Hospital admissions	0.1 (0.3)	0.1 (0.4)	0.0 (0.0)	.0003

^a Participants treated with apremilast at time of survey.

^b Number of office visits, visits for office-based tests/procedures, visits for phototherapy sessions during the preceding 3 months, visits to the ER/urgent care clinic, or hospital administration over the preceding 3 months.

ER: emergency room; HCRU: health care resource use; SD: standard deviation.

Data availability statement

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