Dermatologist preferences for first-line therapy of moderate to severe psoriasis in healthy adult patients.

Abstract

BACKGROUND:

Despite increasing therapies for moderate to severe psoriasis, dermatologists' treatment preferences are unknown.

OBJECTIVE:

We sought to assess dermatologists' preferences for first-line treatments and their selection determinants.

METHODS:

We surveyed 1000 US dermatologists (500 National Psoriasis Foundation and 500 American Academy of Dermatology members who treat psoriasis) about their preferences for first-line treatment of moderate to severe psoriasis in healthy adults of childbearing age using standardized patient vignettes.

RESULTS:

The response rate was 39% (N = 387). Preferred therapies for male and female patients were: ultraviolet (UV) B (40% and 56%, respectively), etanercept (15% and 19%), methotrexate (16% and 4%), and adalimumab (12% and 10%). Of respondents, 66% administered phototherapy in their practice. After adjusting for all physician characteristics, those preferring first-line UVB for male or female patients were significantly more likely to have phototherapy in their practice (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.8-6.6 and OR 2.8, 95% CI 1.5-5.3, respectively) and to have used UVB in more than 10 patients in the last 3 months (OR 8.0, 95% CI 3.9-16.4; OR 9.6, 95% CI 4.3-21.6). Dermatologists in the Midwest were more likely than those in the Northeast to prefer adalimumab first line for male and female patients.

LIMITATIONS:

We surveyed only dermatologists with interest in treating psoriasis and elicited their treatment preferences for a single base case scenario. Treatment preferences may differ between survey respondents and nonrespondents.

CONCLUSION:

UVB is most commonly preferred as a first-line treatment for moderate to severe psoriasis in healthy adults, and preferences vary based on region, phototherapy availability, and prior treatment use.

• Authors: Joy Wan, Katrina Abuabara, Andrea B Troxel, Daniel B Shin, Abby S Van Voorhees, Bruce F Bebo Jr, Gerald G Krueger, Kristina Callis Duffin, Joel M Gelfand
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 66 Issue 3 Pg. 376-86 (Mar 2012) ISSN: 1097-6787 [Electronic] United States
• PMID: 21856040 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• Immunoglobulin G
• Immunosuppressive Agents
• Receptors, Tumor Necrosis Factor
• Adalimumab
• Etanercept
• Methotrexate

Topics

• Adalimumab
• Adult
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Attitude of Health Personnel
• Dermatology (methods)
• Etanercept
• Female
• Health Care Surveys
• Humans
• Immunoglobulin G (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Professional Practice
• Psoriasis (diagnosis, drug therapy)
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Severity of Illness Index
• Ultraviolet Therapy