Purpose: Psoriasis (PsO) patients may have increased outpatient healthcare resource utilization during the times when they are experiencing disease flares. Literature reports that health plans may reimburse up to $86.6 million nationally on outpatient physician visits for approximately 1.4 million Americans with PsO.1 The purpose of this study was to assess PsO flaring and the impact of the frequency of flares on PsO-related quality of life outcomes.
Method: Cross-sectional data were collected via the Psoriasis Patient Study Project conducted March 1-April 30, 2010. Study participants were recruited from an Internet panel, aged ≥18 yrs, and self-identified as having PsO. Current treatment type [biologics (BIO), prescription oral (Rx/Oral), phototherapy (PT), prescription topical (Rx/Topical), over-the-counter (OTC), and untreated (UT)] and self-reported disease severity (mild, moderate, severe) were reported. Frequent flaring was defined as occurring continuously or more than once per week, as reported by the patient. Infrequent flaring was defined as occurring less frequent than once per week. Outcomes were measured by the Dermatology Life Quality Index (DLQI) and Skindex-16 instruments.
Result: A total of 1,017 respondents completed the survey (57% female; mean age = 53 yrs; mean 17 yrs of diagnosed PsO). When asked about disease severity, 60% reported mild disease, 35% moderate, and 5% severe. Overall, 28% of all PsO patients reported their disease as continuously flaring, with a significantly higher proportion of those with severe (60%) and moderate (36%) disease experiencing continuous flares compared with mild (20%; p<0.05). BIO use was significantly greater in patients with severe (33%) and moderate (17%) disease compared to those with mild disease (5%; p<0.05). Fewer moderate/severe BIO-treated patients (n=79) reported continuous flares (25%) compared to moderate/severe Rx/Topical or moderate/severe UT patients (47% for both; p<0.05). Patient-reported frequent flaring was statistically significantly associated with worsened outcomes compared to infrequent flaring.
Conclusion: Greater PsO disease severity may be associated with frequent flaring and worsened outcomes. Once biologic-experienced, 1 in 4 moderate to severe patients reported continuous flares. There is still an unmet need for treatment options offering better flare control. 1 Javitz HS et al. J Am Acad Dermatol. 2002;46(6):850-860.