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Barriers to the prescription of systemic therapies for moderate-to-severe psoriasis––a multinational cross-sectional study

Archives of Dermatological Research volume 305, pages 899–907 (2013)Cite this article

Abstract

Despite the availability of a plethora of approved systemic treatments, high proportions of patients with moderate-to-severe psoriasis do not receive systemic treatment. This study aims at identifying barriers that hinder dermatologists from prescribing systemic treatments for psoriasis. A cross-sectional online survey in six countries (Canada, Germany, Spain, France, Italy, UK) was performed among 300 dermatologists, assessing the relevance of 15 potential barriers towards prescribing acitretin, cyclosporine, methotrexate, adalimumab, etanercept, infliximab and ustekinumab. Multivariate regression analyses were used to explore provider characteristics related to these barriers. Treatment barriers are perceived differently in the countries investigated, with Spanish, Italian and Canadian dermatologists being particularly concerned about the safety of methotrexate and Canadian dermatologists about the safety of cyclosporine. In general, safety concerns were the most important barrier to the use of cyclosporine, (18 % of participants’ moderate/9 % strong or very strong barrier). Costs were being perceived as a strong or very strong barrier to the use of the different biologics by 19–24 % of the participants. Overall, country and work place were the most important determinants of treatment barriers. Sex, age, training, position and experience were minor determinants of treatment barriers. Medical reasons such as safety concerns or an inappropriate risk-benefit profile are particularly relevant barriers to the prescription of conventional treatments; whereas for biological treatments, economic reasons such as costs are more prevalent. Country specific analysis showed national differences in the perception of safety. The treatment barriers identified in this exploratory study should be confirmed in further health services research.

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Acknowledgments

This paper summarises the guidelines results from the Progressive Psoriasis Initiative (PPI) Treatment Barriers survey. The medical research company Medefield performed the survey. The PPI programme including the costs for the use of Medefield was funded through an educational grant from Abbott. No payments were made to the authors for the writing of this manuscript. Abbott had no involvement in the development of the manuscript. Abbott provided funding to the medical communications agency Lucid, Burleighfield House, Loudwater, UK, to manage the PPI programme.

Conflict of interest

AN has received honoraria for CME talks and scientific research with indirect sponsoring from Abbott, Pfizer, Jansen Cilag and Bayer Health Care. His employee, the Division of evidence based Medicine at Charité - Universitätsmedizin Berlin has received research grants from Abbott and Pfizer.

UM has been an advisor and/or received speakers honoraria and/or received grants and/or participated in clinical trials of the following companies: Abbott/AbbVie, Almirall-Hermal, Amgen, BASF, Biogen Idec, Celgene, Centocor, Eli Lilly, Forward Pharma, Galderma, Janssen, Leo Pharma, Medac, MSD, Miltenyi Biotech, Novartis, Pfizer, Teva, VBL, Xenoport.

KK has served as advisor, speaker and/or investigator for Abbott, Janssen, Leo Pharma, MSD and Pfizer.

EdJ has received research grants for the independent research fund of the department of dermatology of University Medical Centre St. Radboud Nijmegen, the Netherlands from Merck-Serono, Wyeth, Abbott, Pfizer, and Janssen, and has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Janssen, MSD, and Pfizer.

LP has served as consultant and/or paid speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Celgene, Centocor, Janssen-Cilag, Leo, Merck, MSD (formerly Schering-Plough), Novartis, Pfizer (formerly Wyeth).

KR has served as consultant and/or paid speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Biogen Idec, Celgene, Centocor, Janssen-Cilag, Leo, Medac, Merck, MSD (formerly Essex, Schering-Plough), Novartis, Pfizer (formerly Wyeth).

RBW has acted a consultant and or speaker for Abbott, Janssen, MSD, Pfizer, Novartis and Leo.

RNW: None declared.

CK: None declared.

JS has acted as a paid speaker for Novartis and Abbott, received grants from Pfizer (formerly Wyeth) and from Novartis.

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Authors and Affiliations

  1. Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité––Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    A. Nast & R. Werner

  2. Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig–Holstein, Kiel, Germany

    U. Mrowietz

  3. Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark

    K. Kragballe

  4. Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    E. M. G. J. de Jong

  5. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    L. Puig

  6. Dermatologikum Hamburg, Hamburg, Germany

    K. Reich

  7. Dermatology Centre, Salford Royal NHS Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

    R. B. Warren

  8. Centre for evidence-based healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany

    C. Kopkow & J. Schmitt

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  1. A. Nast
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  2. U. Mrowietz
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  3. K. Kragballe
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  4. E. M. G. J. de Jong
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  5. L. Puig
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  6. K. Reich
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  7. R. B. Warren
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  8. R. Werner
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  10. J. Schmitt
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Correspondence to A. Nast.

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Nast, A., Mrowietz, U., Kragballe, K. et al. Barriers to the prescription of systemic therapies for moderate-to-severe psoriasis––a multinational cross-sectional study. Arch Dermatol Res 305, 899–907 (2013). https://doi.org/10.1007/s00403-013-1372-3

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  • DOI: https://doi.org/10.1007/s00403-013-1372-3

Keywords

  • Psoriasis
  • Treatment barrier
  • Systemic treatment
  • Biologic
  • Cross-sectional study