Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis

BACKGROUND: Despite widespread dissatisfaction and low treatment persistence in moderate-to-severe psoriasis, patients’ reasons behind treatment discontinuation remain poorly understood. OBJECTIVES: To characterize patient-reported reasons for discontinuing commonly used treatments for moderate-to-severe psoriasis in real-world clinical practice. METHODS: 1,095 patients with moderate-to-severe plaque psoriasis from ten dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments. RESULTS: A total of 2,231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (p < 0.001). The frequency of each cited discontinuation reasons differed by treatment (all p < 0.01). Patients who received etanercept (OR 5.19; 95% CI, 3.23–8.33) and adalimumab (2.10; 1.20–3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (0.34; 0.23–0.49), adalimumab (0.48; 0.30–0.75), and UVB phototherapy (0.21; 0.14–0.31) were less likely to cite side effects than those who received methotrexate, while those who received acitretin (1.56; 1.08–2.25) were more likely to do so. Patients who underwent UVB phototherapy were more likely to cite an inability to afford treatment (7.03; 3.14–15.72). LIMITATIONS: The study is limited by its reliance on patient recall. CONCLUSIONS: Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control