Real-World Assessment of Advanced Psoriasis Therapies in the US: Clinical Burden, Treatment Patterns, and Perceptions

Abstract

Introduction The treatment landscape for moderate-to-severe psoriasis (PsO) has recently expanded with the introduction of oral advanced therapies (OATs), tested in clinical trials with inclusion criteria of Psoriasis Area and Severity Index (PASI) ≥12 or body surface area (BSA) ≥10%. Real-world data on patients prescribed these newer treatment options remain limited. This analysis compares patients receiving biologics and OATs in real-world practice.

Methods Data were sourced from the Adelphi Real World PsO Disease Specific Programm™, a cross-sectional survey of dermatologists and their patients with PsO in the United States between April 2024 – February 2025. Dermatologists reported characteristics, treatment history and reasons for switch for six consecutively consulting adult patients with PsO. Patients reported treatment satisfaction and administration preference.

Patients receiving advanced therapies (ATs) at the time of survey were grouped: OATs (apremilast or deucravacitinib) and biologics/biosimilars, compared using bivariate analysis.

Results Overall, 92 dermatologists provided data on 517 patients with PsO receiving AT, 134 prescribed OATs and 383 prescribed biologics at the time of survey.

Across biologic and OAT patients, mean age was 44.3 and 41.4 years old, 56.0% and 44.0% were male with 24.8% and 18.7% patients having a PsA diagnosis, respectively.

At AT initiation, a greater proportion of patients had ≥10% BSA affected in the biologic group compared to the OAT group (59.4% vs 44.7%, p=0.0170). Biologic patients had more body areas affected overall (mean (SD) 4.3(3.0) vs 3.5(2.3), p=0.0070), but the proportion of patients with special areas affected was similar (67.2% vs 65.4%, respectively, p=0.7451). More biologic patients had a PASI score ≥12 (28.0% vs 14.0%, p=0.0012) and more were classed severe via physician global assessment (25.9% vs 6.8%, p<0.0001).

Lack of efficacy was the primary reason for switching to the current treatment, reported in the majority of OAT (66.7%) and biologic (72.8%) patients. Notably, OAT patients more commonly switched from solely topicals (69.1% vs 31.3%, p<0.0001), while biologic patients more often switched from another biologic (7.4% vs 34.1%, p<0.0001).

While a majority of patients were satisfied with the performance of their current treatment, 29.6% and 40.7% of biologic and OAT patients respectively still were not satisfied or believed their treatment could perform better. Additionally, 46.4% of biologic patients reported preferring oral administration.

Conclusion Inclusion criteria in clinical trials are not reflective of the real-world patients who receive OATs and biologics, suggesting a potential need for widened criteria in future trials to enroll more representative patient populations.

Real-world data reveal room for improvement in satisfaction with AT and unmet preferences for convenience and efficacy. These gaps highlight the need for more effective, patient-centered therapies.