The Association Between Patient-Reported Disease Burden and Treatment Switching in Patients with Plaque Psoriasis Treated with Nonbiologic Systemic Therapy

Introduction: Better understanding of the relationship between quality of life and treatment patterns in psoriasis may help guide therapeutic algorithms. This study evaluated the association between patient-reported disease burden and treatment switching from nonbiologic to biologic therapy in patients with plaque psoriasis enrolled in the CorEvitas Psoriasis Registry. Methods: This cross-sectional study included biologic-naive patients aged ≥18 years who had used nonbiologic systemic therapy 28–365 days prior to their registry enrollment between April 2015 and August 2022. A switch to biologic therapy was defined as the introduction of biologic treatment up to 45 days post-enrollment, in addition to or in place of the initial nonbiologic systemic therapy. Measures of patient-reported disease burden collected at enrollment were: the Dermatology Life Quality Index (DLQI); Work Productivity and Activity Impairment Index (WPAI); itch, skin pain, fatigue, and Patient Global Assessment (PGA), measured on visual analog scales (VAS); and the EuroQoL 5-Dimension, 3-Level (EQ-5D-3L) questionnaire. The association between each patient-reported disease burden measure and switching to biologic therapy was evaluated using multivariable logistic regression models, adjusting for age, sex, race, ethnicity, work status, body mass index, psoriasis duration, psoriatic arthritis status, disease severity, number of prior nonbiologic therapies used, and history of difficult-to-treat areas. A secondary analysis stratified each model by patients with PASI scores ≤2 or >2. Results: Of 848 patients included in the analysis, 323 (38.1%) switched to biologic treatment at enrollment. Significantly higher odds of switching were observed for patients reporting greater vs lesser burden on the DLQI (adjusted odds ratio [aOR] = 1.55; 95% CI, 1.08–2.23); VAS measures of itch (aOR = 2.14; 95% CI, 1.49–3.08), skin pain (aOR = 2.18; 95% CI, 1.45–3.29), fatigue (aOR = 1.66; 95% CI, 1.15–2.40), or PGA (aOR = 3.09; 95% CI, 1.94–4.91); or WPAI activities impairment (aOR = 2.51; 95% CI, 1.72–3.65). Numerically higher odds of switching were observed for greater vs lesser burden measured by EQ-5D-3L. In the secondary analysis, 52 of 330 patients with PASI scores ≤2 (15.8%) switched to biologic treatment. Among patients with PASI scores ≤2, those with greater vs lesser burden for VAS itch, skin pain, or PGA, or with impairment of their usual activities as measured by EQ-5D-3L had significantly higher odds of switching to biologic treatments. Conclusion: Data collected from real-world patients with plaque psoriasis suggest that, in addition to disease severity, patient-reported disease burden, such as itch and skin pain, may be an important driver of switching from a nonbiologic to biologic therapy, even among patients with a low degree of skin involvement. Sponsored by: CorEvitas.