Retrospective analysis of the effectiveness and costs of traditional treatments for moderate-to-severe psoriasis: A single-center, Italian study

Background: Current guidelines recommend the use of systemic therapy and phototherapy for the treatment of moderate-to-severe plaque psoriasis. Objectives: To evaluate the effectiveness, impact on health status perception, and costs of traditional systemic therapies and phototherapy in real-life patients with moderate-to-severe psoriasis. Methods: Retrospective analysis of data from 100 psoriatic patients referring to a dermatology clinic in Italy and treated with traditional therapies. Results: Patients were predominantly treated with cyclosporine (72%). Cyclosporine was associated with fewer treatment discontinuations due to lack of efficacy (37%) compared with methotrexate (65%), acitretin (67%) and phototherapy (50%). Rates of treatment discontinuation due to adverse events were: cyclosporine (24%), methotrexate (9%), acitretin (25%) and phototherapy (0%). Improvements in PASI scores were comparable between treatments. The need for topical therapy was reduced with cyclosporine versus other therapies (35% vs 71%, p = 0.0009); respectively, 33% of patients treated with cyclosporine versus 14% of patients receiving other therapies perceived an improvement in their health status (p = 0.0018). Mean total per-patient direct costs of the first treatment cycle were higher with cyclosporine than with other therapies (Euro1812.85 vs Euro648.90, p<0.0001). Conclusions: Cyclosporine was effective even if more expensive than other traditional therapies. Nevertheless patients' perception of improvement was quite low.