Assessing Barriers and Educational Needs in Treatment of ......Issues/Concerns for Emerging Agents...
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Jovana Lubarda 1 , PhD, Jelena Spyropoulos 1 , PhD 1Medscape, LLC, New York, NY, USA Psoriasis is a common, chronic, inflammatory, multisystem disease that can significantly impair quality of life. 1 It affects approximately 2% of US adults, and this condition was recently classified as a global health priority by the World Health Organization. 2 Approximately 20% of patients experience moderate to severe disease, which constitutes having up to 10% of their body surface area covered and includes involvement of the hands, feet, facial, or genital regions, which may interfere significantly with activities of daily life. 1 However, in a recent survey that included more than 5600 patients with psoriasis, more than half were dissatisfied with their treatment; this continues to remain a challenge, despite the availability of newer treatment options .3 In addition, many patients often discontinue therapy due to loss of efficacy or adverse effects, and the recurring nature of this disorder along with the current quality of care may lead to significant psychological distress. The goals of this study were to determine physicians’ current barriers in the management of moderate to severe psoriasis and to identify areas of continuing medical education (CME) need. • A total of 50 physicians completed the survey. • 41% reported treating 4 to 6 cases of moderate to severe psoriasis per week and 38% reported treating 7 or more cases per week (Figure 1). • Half of the physicians reported prescribing biologics for only 20% of their patients with moderate to severe psoriasis, and their preferences for treatment in these cases were as follows: 49% anti-tumor necrosis factor (anti-TNF) agents, 29% oral methotrexate, 16% topical corticosteroid therapy, and 4% anti- IL12/23 (Figures 2 and 3). • The cited barriers to improving patient care were, in order of importance, 29% financial, 28% adherence/tolerability, 15% undertreatment, and 14% each for early diagnosis and management of comorbidities (Figure 4). • When participants were asked to rate their knowledge of emerging psoriasis therapies and mechanisms using a Likert scale (1=no knowledge; 7=in-depth knowledge), only 8% reported having in-depth knowledge (mean ± SD was 4.9 [± 1.3]) (Figure 5). • Concerns about emerging therapies included cost (73%), safety (67%), lack of knowledge of available data (43%), lack of real-world data (25%), and efficacy (20%) (Figure 6). • Approximately one-third of the participants reported using an online source to answer at least 6 psoriasis-related patient inquiries per month. • Future CME needs, in order of highest importance, were individualizing first-line therapies, managing comorbidities, strategies for overcoming nonadherence, second-line therapy selection, and therapy mechanisms in the context of psoriasis pathophysiology. Results Methods Assessing Barriers and Educational Needs in Treatment of Moderate to Severe Psoriasis • A 10-question online survey was administered by an accredited CME provider to assess management approaches for moderate to severe psoriasis, knowledge of emerging therapies, and preference for future CME opportunities. • Physicians members of the website participated without monetary compensation or charge and only those who treat at least 1 patient with psoriasis each week were included in the analysis. • The survey was launched online on October 15th, 2014 and data were collected for 1 month. Outside of cost, undertreatment with biologics and managing adherence were the key issues reported among physicians treating patients with moderate to severe psoriasis. Physicians would benefit from foundational and case-based CME -- which could be delivered online -- on therapy selection and personalization, clinical data on current and emerging biologics, and comprehensive management of psoriasis including comorbidities. Acknowledgements The educational activity was developed by Medscape Education. For more information, contact Jovana Lubarda, PhD, Associate Director, Educational Strategy, Medscape, LLC, [email protected]. Conclusions In general, what is your treatment approach for a patient who presents with moderate to severe psoriasis (30% body surface area)? (n=50) What issues or concerns do you have about emerging agents for psoriasis treatment? [Select all that apply.] 0% 10% 20% 30% 40% 50% 60% Topical corticosteroid therapy Oral methotrexate Anti-TNF agents Anti IL12/23 therapy Other, please specify (refer to dermatologist) F r e q u e n c y o f T r e a t m e n t U s e T r e a t m e n t f o r M o d e r a t e t o S e v e r e P s o r i a s i s 2% 4% 49% 29% 16% Survey participants’ treatment preferences for moderate to severe psoriasis (n=50). Survey participants’ cited issues or concerns with emerging agents for psoriasis treatment (n=50). FIGURE 3: FIGURE 6: How many patients with moderate to severe psoriasis do you see per week? (n=50) 0% 22% 41% 6% 0% 10% 20% 30% 40% 50% 0 1 to 3 4 to 6 7 to 9 10 to 12 13 or more P e r c e n t R e s p o n s e s N u m b e r o f P a t i e n t s p e r W e e k 16% 16% Number of patients with moderate to severe psoriasis treated by survey participants (n=50). FIGURE 1: Survey participants’ cited barriers toward improving patient care in psoriasis (n=50). FIGURE 4: What percentage of your patients with psoriasis do you currently treat with biologics? (n=50) 0% 10% 20% 30% 40% 50% 0-5% 6-10% 11-20% Over 20% P e r c e n t a g e o f P h y s i c i a n s T r e a t i n g W i t h B i o l o g i c s P e r c e n t a g e o f P a t i e n t s T r e a t e d W i t h B i o l o g i c s Percentage of survey participants’ patients currently treated with biologics (n=50). FIGURE 2: What are the most important barriers to improving patient care in psoriasis? [Select all that apply.] (n=50) 14% 28% 14% 29% 15% Early diagnosis Treatment adherence/ tolerability Management of associated comorbidities Financial/cost considerations Disease progression due to under-treatment FIGURE 5: No knowledge = 1 2 3 4 5 6 In depth knowledge = 7 Mean Median Std. Dev. 0% 4% 14% 10% 37% 27% 8% 4.9 5 1.3 Survey participants’ rating of knowledge about emerging therapies and their mechanism of action in psoriasis using a Likert scale (1 =no knowledge; 7=in depth knowledge) (n=50). Background 0% 10% 20% 30% 40% 50% 60% 70% 80% Lack of knowledge of efficacy/safety data Lack of real world data on new agents Cost of agents Efficacy concerns Safety concerns P e r c e n t o f R e s p o n s e f o r I s s u e s / C o n c e r n s I s s u e s / C o n c e r n s f o r E m e r g i n g A g e n t s i n P s o r i a s i s T r e a t m e n t I do not have any issues about new agents 4% 67% 20% 73% 25% 43% 1. Menter A, Korman NJ, et al; American Academy of Dermatology Work Group. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137-174. 2. World Health Organization. Sixty-Seventh World Health Assembly. Agenda item 13.5. Psoriasis. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R9-en.pdf. Accessed June 10, 2015. 3. Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol . 2013;149:1180-1185 References
Transcript of Assessing Barriers and Educational Needs in Treatment of ......Issues/Concerns for Emerging Agents...
Jovana Lubarda1, PhD, Jelena Spyropoulos1, PhD 1Medscape, LLC, New York, NY, USA
Psoriasis is a common, chronic, inflammatory, multisystem disease that can significantly impair quality of life.1 It affects approximately 2% of US adults, and this condition was recently classified as a global health priority by the World Health Organization.2 Approximately 20% of patients experience moderate to severe disease, which constitutes having up to 10% of their body surface area covered and includes involvement of the hands, feet, facial, or genital regions, which may interfere significantly with activities of daily life.1 However, in a recent survey that included more than 5600 patients with psoriasis, more than half were dissatisfied with their treatment; this continues to remain a challenge, despite the availability of newer treatment options.3 In addition, many patients often discontinue therapy due to loss of efficacy or adverse effects, and the recurring nature of this disorder along with the current quality of care may lead to significant psychological distress. The goals of this study were to determine physicians’ current barriers in the management of moderate to severe psoriasis and to identify areas of continuing medical education (CME) need.
• A total of 50 physicians completed the survey. • 41% reported treating 4 to 6 cases of
moderate to severe psoriasis per week and 38% reported treating 7 or more cases per week (Figure 1).
• Half of the physicians reported prescribing biologics for only 20% of their patients with moderate to severe psoriasis, and their preferences for treatment in these cases were as follows: 49% anti-tumor necrosis factor (anti-TNF) agents, 29% oral methotrexate, 16% topical corticosteroid therapy, and 4% anti-IL12/23 (Figures 2 and 3).
• The cited barriers to improving patient care were, in order of importance, 29% financial, 28% adherence/tolerability, 15% undertreatment, and 14% each for early diagnosis and management of comorbidities (Figure 4).
• When participants were asked to rate their knowledge of emerging psoriasis therapies and mechanisms using a Likert scale (1=no knowledge; 7=in-depth knowledge), only 8% reported having in-depth knowledge (mean ± SD was 4.9 [± 1.3]) (Figure 5).
• Concerns about emerging therapies included cost (73%), safety (67%), lack of knowledge of available data (43%), lack of real-world data (25%), and efficacy (20%) (Figure 6).
• Approximately one-third of the participants reported using an online source to answer at least 6 psoriasis-related patient inquiries per month.
• Future CME needs, in order of highest importance, were individualizing first-line therapies, managing comorbidities, strategies for overcoming nonadherence, second-line therapy selection, and therapy mechanisms in the context of psoriasis pathophysiology.
Results
Methods
Assessing Barriers and Educational Needs in Treatment of Moderate to Severe Psoriasis
• A 10-question online survey was administered by an accredited CME provider to assess management approaches for moderate to severe psoriasis, knowledge of emerging therapies, and preference for future CME opportunities.
• Physicians members of the website participated without monetary compensation or charge and only those who treat at least 1 patient with psoriasis each week were included in the analysis.
• The survey was launched online on October 15th, 2014 and data were collected for 1 month.
Outside of cost, undertreatment with biologics and managing adherence were the key issues reported among physicians treating patients with moderate to severe psoriasis. Physicians would benefit from foundational and case-based CME -- which could be delivered online -- on therapy selection and personalization, clinical data on current and emerging biologics, and comprehensive management of psoriasis including comorbidities.
Acknowledgements
The educational activity was developed by Medscape Education. For more information, contact Jovana Lubarda, PhD, Associate Director, Educational Strategy, Medscape, LLC, [email protected].
Conclusions
In general, what is your treatment approach for a patient who presents with moderate to severe
psoriasis (30% body surface area)? (n=50)
What issues or concerns do you have about emerging agents for psoriasis treatment?
[Select all that apply.]
0%
10%
20%
30%
40%
50%
60%
Topical corticosteroid
therapy
Oral methotrexate
Anti-TNF agents Anti IL12/23 therapy
Other, please specify (refer to dermatologist)
Freq
uenc
y of
Tre
atm
ent U
se
Treatment for Moderate to Severe Psoriasis
2% 4%
49%
29%
16%
Survey participants’ treatment preferences for moderate to severe psoriasis (n=50).
Survey participants’ cited issues or concerns with emerging agents for
psoriasis treatment (n=50).
Figure 3:
Figure 6:
How many patients with moderate to severe psoriasis do you see per week? (n=50)
0%
22%
41%
6%
0%
10%
20%
30%
40%
50%
0 1 to 3 4 to 6 7 to 9 10 to 12 13 or more
Per
cent
Res
pons
es
Number of Patients per Week
16% 16%
Number of patients with moderate to severe psoriasis treated by survey participants (n=50).Figure 1:
Survey participants’ cited barriers toward improving patient care in psoriasis (n=50).
Figure 4:
What percentage of your patients with psoriasis do you currently treat with biologics? (n=50)
0%
10%
20%
30%
40%
50%
0-5% 6-10% 11-20% Over 20% Per
cent
age
of P
hysi
cian
s Tr
eatin
g
With
Bio
logi
cs
Percentage of Patients Treated With Biologics
Percentage of survey participants’ patients currently treated with biologics (n=50).
Figure 2:
What are the most important barriers to improving patient care in psoriasis?
[Select all that apply.] (n=50)
14%
28%
14%
29%
15% Early diagnosis
Treatment adherence/tolerability
Management of associated comorbidities
Financial/cost considerations
Disease progression due to under-treatment
Figure 5:
No knowledge
= 1 2 3 4 5 6
In depth knowledge
= 7
Mean MedianStd. Dev.
0% 4% 14% 10% 37% 27% 8% 4.9 5 1.3
Survey participants’ rating of knowledge about emerging therapies and their
mechanism of action in psoriasis using a Likert scale (1 =no knowledge; 7=in depth knowledge) (n=50).
Background
0%
10%
20%
30%
40%
50%
60%
70%
80%
Lack of knowledge of efficacy/safety
data
Lack of real world data on new
agents
Cost of agents Efficacy concerns Safety concerns
Per
cent
of R
espo
nse
for
Is
sues
/Con
cern
s
Issues/Concerns for Emerging Agents in Psoriasis Treatment
I do not have any issues about
new agents
4%
67%
20%
73%
25%
43%
1. Menter A, Korman NJ, et al; American Academy of Dermatology Work Group. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137-174.
2. World Health Organization. Sixty-Seventh World Health Assembly. Agenda item 13.5. Psoriasis. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R9-en.pdf. Accessed June 10, 2015.
3. Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149:1180-1185
References
