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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gillard SE, Finlay AY (2005) Current management of psoriasis in the UK: patterns of prescribing and resource use in primary care. Int J Clin Pract 59:1260–1267
Maza A, Richard MA, Aubin F, Ortonne JP, Prey S, Bachelez H, Beylot-Barry M, Bulai-Livideanu C, Lahfa M, Nougue J, Mengual X, Le Moigne M, Lauwers-Cances V, Paul C (2012) Significant delay in the introduction of systemic treatment of moderate to severe psoriasis: a prospective multicentre observational study in outpatients from hospital dermatology departments in France. Br J Dermatol 167:643–648
Moreno-Ramirez D, Fonseca E, Herranz P, Ara M (2010) Treatment of moderate-to-severe psoriasis in clinical practice: a survey of Spanish dermatologists. Actas Dermosifiliogr 101:858–865
Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B (2011) S3-guidelines for the treatment of psoriasis vulgaris update 2011. J Dtsch Dermatol Ges 9(Suppl 2):S1–S104
Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B (2012) German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res 304:87–113
Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B (2012) S3-guidelines on the treatment of psoriasis vulgaris (english version) update. J Dtsch Dermatol Ges 10(Suppl 2):S1–S95
Nast A, Reytan N, Rosumeck S, Erdmann R, Rzany B (2008) Low prescription rate for systemic treatments in the management of severe psoriasis vulgaris and psoriatic arthritis in dermatological practices in Berlin and Brandenburg, Germany: results from a patient registry. J Eur Acad Dermatol Venereol 22:1337–1342
Nederlandse Vereniging voor Dermatologie en Venerologie (NVDV) and the Institute for Healthcare Improvement (CBO) (2003) Dutch guideline for the treatment of severe psoriasis (ultraviolet B, ultraviolet A in combination with oral psoralen, cyclosporin A, methotrexate and acitretine). Van Zuiden Communications. http://www.cbo.nl/Downloads/376/rl_psoriasis_2005.pdf
Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret L, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Honigsmann H, Hussain M, Jobling R, Karvonen SL, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne JP, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H, Thio HB, van de Kerkhof P, Rzany B (2009) European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 23(Suppl 2):1–70
Poulin Y, Papp KA, Wasel NR, Andrew R, Fraquelli E, Bernstein G, Chan D (2010) A canadian online survey to evaluate awareness and treatment satisfaction in individuals with moderate to severe plaque psoriasis. Int J Dermatol 49:1368–1375
Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM (1999) Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 41:401–407
Schmid-Ott G, Malewski P, Kreiselmaier I, Mrowietz U (2005) Psychosocial consequences of psoriasis––an empirical study of disease burden in 3,753 affected people. Hautarzt 56:466–472
Smith CH, Anstey AV, Barker JN, Burden AD, Chalmers RJ, Chandler D, Finlay AY, Griffiths CE, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD (2005) British association of dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 153:486–497
Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T (2004) Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc 9:136–139
Vena GA, Altomare G, Ayala F, Berardesca E, Calzavara-Pinton P, Chimenti S, Giannetti A, Girolomoni G, Lotti T, Martini P, Mazzaglia G, Peserico A, Puglisi Guerra A, Sini G, Cassano N, Cricelli C (2010) Incidence of psoriasis and association with comorbidities in Italy: a 5-year observational study from a national primary care database. Eur J Dermatol 20:593–598
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.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-013-1372-3