Patient Disease Characteristics and Treatment Patterns in Mild-Moderate Psoriasis: Results from Real-World Clinical Practice in the United States (PROSPECT Study)

IntroductionPsoriasis (PsO) is a common dermatological condition. Psoriasis severity is commonly characterized by percentage body surface area (BSA) affected, with < 3% BSA considered mild disease and 3-10% moderate disease. Treatment options for and knowledge of clinical practice patterns in patients with mild PsO are limited. Here, we use real-world data to characterize patients diagnosed with mild and moderate PsO and their clinical management. MethodsData were derived from the Adelphi Real World PsO Disease Specific Programme (TM), a cross-sectional survey of dermatologists and adult patients with PsO in the USA, between December 2021 and March 2022. Dermatologists reported demographic and clinical details. Patients reported treatment satisfaction and quality of life using patient-reported outcome measures. Patients were stratified by physician-reported severity at diagnosis (mild/moderate) and compared using bivariate analyses. ResultsOut of 389 patients, 18.5% were diagnosed with mild PsO. The majority were female, white, and employed. Patients diagnosed with moderate PsO had higher body mass index (p = 0.002) and longer disease duration (p = 0.041). Only 22.0% of patients diagnosed with mild PsO had BSA < 3% at diagnosis, and 48.1% of patients diagnosed as moderate PsO had BSA < 10%. BSA improvement following initiation of current treatment was higher among patients diagnosed with moderate PsO (p < 0.001). Those diagnosed with moderate PsO more commonly had involvement of the elbows (p = 0.003), legs (p = 0.002), knees (p < 0.001), soles (p = 0.035), and back (p = 0.004) at diagnosis. Cracked skin, redness, and tender skin (p < 0.001 for all) were more common among those diagnosed with moderate PsO. Both groups mostly received topical agents; however, those diagnosed with moderate PsO more commonly received systemic (p < 0.001) or biologic (p = 0.002) treatment. Patients diagnosed with moderate PsO had lower EQ-5D-5L (p = 0.014) and treatment satisfaction (p = 0.007) scores. ConclusionThese findings suggest that physicians routinely underestimate PsO severity, resulting in possible undertreatment, suboptimal outcomes, and quality-of-life impairments for patients with milder severity PsO.