Significant delay in the introduction of systemic treatment of moderate to severe psoriasis: a prospective multicentre observational study in outpatients from hospital dermatology departments in France

Background There is a low rate of systemic treatment usage in moderate to severe psoriasis. Objectives The primary objective of the present study was to assess the time period between lack of control of moderate to severe psoriasis with topical treatment or phototherapy as perceived by patients and the medical decision to introduce a systemic treatment. Methods This was a prospective multicentre study, which included patients with moderate to severe psoriasis. A standardized questionnaire was completed by physicians and patients at the time the decision was taken to introduce a systemic treatment. The primary outcome was the duration of uncontrolled psoriasis, as estimated by the patient, prior to the introduction of systemic treatment. Factors associated with a delay in systemic treatment defined as > 2 years of uncontrolled psoriasis were assessed. The agreement between patients and physicians on the duration of uncontrolled psoriasis was estimated. Results The study included 142 patients. The mean age was 48 years, the mean Psoriasis Area and Severity index (PASI) was 18.5 and the mean Dermatology Life Quality Index (DLQI) was 12. The median duration of uncontrolled psoriasis estimated by patients and physicians was 3 years and 2 years, respectively. Factors associated with a delay in the introduction of systemic treatment as assessed by patients were fewer than three physician visits since psoriasis was uncontrolled [odds ratio (OR) 3.05; 95% confidence interval (CI) 1.29-7.21], Hospital Anxiety and Depression (HAD) scale < 10 (OR 2.83; 95% CI 1.19-6.71), continuous psoriasis evolution (OR 2 67; 95% CI 1.12-6.42), low consumption of topical treatment (OR 2.35; 95% CI 1.03-5.34). Conclusions There is a significant delay in the introduction of systemic treatment in moderate to severe psoriasis. Patients with low level anxiety and limited use of healthcare resources appear to be at higher risk of experiencing long delays.