Assessment of psoriasis severity in Brazilian patients with chronic plaque psoriasis attending outpatient clinics: a multicenter, population-based cross-sectional study (APPISOT)

Abstract

Purpose: Data on chronic plaque psoriasis severity and its potential clinical and lifestyle implications in the Brazilian population are limited. The primary aim of this study was to assess the clinical severity of plaque psoriasis in Brazil. Further objectives included evaluating potential associations between disease severity and demographic, lifestyle, and clinical characteristics, health-related quality of life (HRQOL), and work productivity.

Materials and methods: This observational (non-interventional) cross-sectional study was conducted in 26 dermatologic clinics across 11 Brazilian states. Psoriasis severity was assessed using investigator judgment and Finlay’s Rule of Tens: a Psoriasis Area and Severity Index (PASI) score >10, a Body Surface Area (BSA) > 10%, or a Dermatology Life Quality Index (DLQI) score >10.

Results: Among 1125 patients, 205 (18.2%) had moderate-to-severe disease. On multiple regression analyses, psoriasis severity was significantly (directly) associated with the presence of physical inactivity and comorbid pain, anxiety, and depression; and significantly (inversely) associated with HRQOL and work productivity.

Limitations: Cross-sectional studies cannot assess temporal trends, and observational studies cannot conclusively determine causality or exclude biases and confounding due to unmeasured variables.

Conclusions: Among Brazilian patients with moderate-to-severe psoriasis, disease severity had far-reaching adverse impacts on lifestyle, comorbidities, HRQOL, and work productivity.

Keywords:

• Epidemiology
• health-related quality of life
• pain
• psoriasis
• severity
• worker productivity

Acknowledgments

Statistical analyses were provided by Maria do Rosario Dias de Oliveira Latorre, PhD (School of Public Health, University of São Paulo). The authors wish to thank all site staff who have assisted in carrying out the APPISOT study, including patient recruitment.

Disclosure statement

The APPISOT study and its report were sponsored (under Grant No. CR100727) by Janssen-Cilag Farmacêutica Ltda. (São Paulo, Brazil), which had a role in study design, data acquisition and interpretation, drafting the manuscript, and the decision to report the findings.

Dr Romiti has served on advisory boards, as a speaker/faculty member, and consultant to, and received grants/research funding and honoraria from, AbbVie, Eli Lilly, Galderma, Janssen, Novartis, UCB and Pfizer. Dr Fabricio has served on advisory boards and as a speaker for, and received honoraria from, AbbVie, Aché Laboratories, Bayer, Galderma, ISDIN, Janssen, La Roche–Posay, LEO Pharma, Novartis, Pfizer, and GlaxoSmithKline (GSK). Dr Souza has served on advisory boards, as a principal investigator for, speaker for and/or consultant to, and received research grants and fees from, Janssen, AbbVie, and Novartis (money paid to Dr Souza and her institution). Dr Galvão has served as a speaker for and received fees from LEO Pharma and Pfizer. Dr Castro has served as a speaker for and received fees from, Janssen (fees paid to Dr Castro), Novartis (money paid to Dr Castro's institution), and Pfizer (money paid to both). Dr Terena has served on advisory boards and as a speaker for and received fees and honoraria from, AbbVie, Janssen, and Novartis. Dr Carneiro and his institution have received grants from Janssen as a local investigator for the trial. Dr Gontijo has served as a speaker for and received honoraria from Novartis. Dr Kobata has served as a principal investigator for and received fees from Janssen (money paid to Dr Kobata's institution). Dr Cestari has served as a principal investigator for and received research grants from Janssen (money paid to Dr Cestari's institution). Dr Roberto Antonio has served as a local investigator for and received grants/research funding from Janssen and Novartis (money paid to Dr Roberto Antonio and his institution), and as a speaker/faculty member for, and received honoraria from Galderma. Dr Marques has served as a local investigator for and received grants/research funding from Janssen (money paid to Dr Marques and his institution). Dr Arruda has served on advisory boards and as a speaker/faculty member for and received honoraria and residency/fellowship program funding from, Janssen, AbbVie, Novartis and Pfizer, which paid a fellowship program grant to Dr Arruda's institution. Dr Félix has served as an advisory board member and speaker for and received fees and honoraria from AbbVie, Eli Lilly, Janssen, Novartis, and Pfizer. Dr Abulafia has served on advisory boards and as a principal investigator and speaker for and received fees, grant/research funding, and equipment from Janssen, which paid fees to Dr Abulafia's institution (Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil). Drs Ferreira, Medeiros da Silva, Silva, and Juliano Souza are employees of Janssen-Cilag. Drs Oyafuso, de Oliveira, Martins, Chaibub, and Magalhães report no conflicts of interest.