Impact of treatment adherence on psoriasis severity: Insights from a multicenter cross-sectional study in Brazil

Abstract

Background: Psoriasis is a chronic, non-contagious inflammatory skin disease with significant physical and quality-of-life impacts. In Brazil, its estimated incidence is 1.3%. Due to the complexity of the disease, effective management requires addressing multiple factors, with treatment adherence and persistence being critical challenges. Aim: To evaluate the correlation between psoriasis severity and treatment adherence and persistence among patients in Paraná, Brazil. Methods: This cross-sectional study included 133 psoriasis patients treated at the three primary specialized care centers in the state, between January 28, 2022, and December 9, 2022. Results: A negative correlation (−0.102, rs² = 1.04%) was observed between psoriasis severity and treatment adherence. Conversely, there was a positive correlation (0.2444, rs² = 5.97%) between psoriasis severity and treatment discontinuation history. Conclusion: Treatment interruptions were correlated with increased psoriasis severity, whereas higher adherence was associated with milder clinical manifestations. Relevance for patients: These findings underscore the critical role of consistent treatment adherence in managing psoriasis. Interruptions in treatment are linked to more severe forms of psoriasis, highlighting the detrimental effects of non-adherence. In contrast, patients who maintained high levels of adherence experienced less severe symptoms, emphasizing that consistent treatment is key to improved disease control. Strengthening patient-provider collaboration and adherence strategies can improve clinical outcomes and enhance quality of life.

Keywords

Psoriasis / Treatment adherence / Treatment persistence / Disease severity

Funding

This work is supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (Grant no.: 313349/2021-5, 315628/2021-9); INCT-INOVAMED (Grant no.: 465430/2014-7); and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior for scholarships to Kauê Cézar Sá Justo and Fernando Henrique Teixeira Zonzini.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

[1] Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017; 31(2):205-212. doi: 10.1111/jdv.13854

[2] Romiti R, Amone M, Menter A, Miot HA. Prevalence of psoriasis in Brazil - a geographical survey. Int J Dermatol. 2017; 56(8):e167-e168. doi: 10.1111/ijd.13604

[3] Parisi R, Symmons DP, Griffiths CE, et al. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J Invest Dermatol. 2013; 133(2):377-385. doi: 10.1038/jid.2012.339

[4] Parisi R, Iskandar IYK, Kontopantelis E, et al. National, regional, and worldwide epidemiology of psoriasis: Systematic analysis and modelling study. BMJ. 2020; 369:m1590. doi: 10.1136/bmj.m1590

[5] Romiti R, Carvalho AVE, Duarte GV. Consenso brasileiro de psoríase 2020 e algoritmo de tratamento da sociedade brasileira de dermatologia. An Brasil Dermatol (Portuguese). 2021; 96(6):778-781. doi: 10.1016/j.abdp.2021.09.013

[6] Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker J. Psoriasis. Lancet. 2021; 397(10281):1301-1315. doi: 10.1016/S0140-6736(20)32549-6

[7] Campione E, Mazzilli S, Di Prete M, et al. The role of glutathione-S transferase in psoriasis and associated comorbidities and the effect of dimethyl fumarate in this pathway. Front Med (Lausanne). 2022; 9:760852. doi: 10.3389/fmed.2022.760852

[8] Silva MF, Fortes MR, Miot LD, Marques SA. Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) in patients assessed before and after systemic treatment. An Bras Dermatol. 2013; 88(5):760-763. doi: 10.1590/abd1806-4841.20132052

[9] Svoboda SA, Ghamrawi RI, Owusu DA, Feldman SR. Treatment goals in psoriasis: Which outcomes matter most? Am J Clin Dermatol. 2020; 21(4):505-511. doi: 10.1007/s40257-020-00521-3

[10] Murage MJ, Tongbram V, Feldman SR, et al. Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: A systematic literature review. Patient Prefer Adherence. 2018; 12:1483-1503. doi: 10.2147/PPA.S167508

[11] Stein Gold LF. Topical therapies for psoriasis: Improving management strategies and patient adherence. Semin Cutan Med Surg. 2016; 35(2Suppl 2):S36-S44; quiz S45. doi: 10.12788/j.sder.2016.006

[12] Alsubeeh NA, Alsharafi AA, Ahamed SS, Alajlan A. Treatment adherence among patients with five dermatological diseases and four treatment types - a cross-sectional study. Patient Prefer Adherence. 2019; 13:2029-2038. doi: 10.2147/PPA.S230921

[13] Feldman SR, Cline A, Pona A, Kolli SS. Treatment Adherence in Dermatology. Berlin: Springer International Publishing; 2019.

[14] Wang Q, Luo Y, Lv C, et al. Nonadherence to treatment and patient-reported outcomes of psoriasis during the COVID-19 epidemic: A web-based survey. Patient Prefer Adherence. 2020; 14:1403-1409. doi: 10.2147/PPA.S263843

[15] Spuls PI, Lecluse LL, Poulsen ML, Bos JD, Stern RS, Nijsten T. How good are clinical severity and outcome measures for psoriasis?: Quantitative evaluation in a systematic review. J Invest Dermatol. 2010; 130(4):933-943. doi: 10.1038/jid.2009.391

[16] Mucherino S, Rafaniello C, Serino M, et al. Drug utilization and measurement of medication adherence: A real world study of psoriasis in Italy. Pharmaceutics. 2023; 15(12):2647. doi: 10.3390/pharmaceutics15122647

[17] Aoki KC, Wong S, Duong JQ, Feldman SR. Adherence to psoriasis therapies. Dermatol Clin. 2024; 42(3):495-506. doi: 10.1016/j.det.2024.02.010

[18] Sá Justo KC, FIlho AB, Zonzini FHT, Dagostini JS, Faria AR, Tanaka AA, et al. Prevalence of Comorbidities in Patients with Psoriasis in Brazil: Preliminary Results of the Pharmacoepidemiological Study Pso.BRA. Int J Phys Med Rehabil. 2022; 10(6):653.doi: 10.35248/2329-9096.22.10.653

[19] Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1):67-74. doi: 10.1097/00005650-198601000-00007

[20] Finlay AY, Khan GK. Dermatology life quality index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19(3):210-216. doi: 10.1111/j.1365-2230.1994.tb01167.x

[21] Souza AF, Silva MRD, Santos JBD, Almeida AM, Acurcio FA, Alvares-Teodoro J. Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: A prospective observational study. Pharm Pract (Granada). 2021; 19(2):2312. doi: 10.18549/PharmPract.2021.2.2312

[22] Martins GA, Arruda L, Mugnaini ASB. Validação de questionários de avaliação da qualidade de vida em pacientes de psoríase. An Brasil Dermatol. 2004; 79:521-535.

[23] Avazeh Y, Rezaei S, Bastani P, Mehralian G. Health literacy and medication adherence in psoriasis patients: A survey in Iran. BMC Prim Care. 2022; 23(1):113. doi: 10.1186/s12875-022-01719-6

[24] Devaux S, Castela A, Archier E, et al. Adherence to topical treatment in psoriasis: A systematic literature review. J Eur Acad Dermatol Venereol. 2012;26Suppl 3:61-67. doi: 10.1111/j.1468-3083.2012.04525.x

[25] Piragine E, Petri D, Martelli A, et al. Adherence and persistence to biological drugs for psoriasis: Systematic review with meta-analysis. J Clin Med. 2022; 11(6):1506. doi: 10.3390/jcm11061506

[26] Aleshaki JS, Cardwell LA, Muse ME, Feldman SR. Adherence and resource use among psoriasis patients treated with biologics. Expert Rev Pharmacoecon Outcomes Res. 2018; 18(6):609-617. doi: 10.1080/14737167.2018.1512408

[27] Bronckers I, Paller AS, West DP, et al. A comparison of psoriasis severity in pediatric patients treated with methotrexate vs biologic agents. JAMA Dermatol. 2020; 156(4):384-392. doi: 10.1001/jamadermatol.2019.4835

[28] Dommasch ED, Lee MP, Joyce CJ, Garry EM, Gagne JJ. Drug utilization patterns and adherence in patients on systemic medications for the treatment of psoriasis: A retrospective, comparative cohort study. J Am Acad Dermatol. 2018; 79(6):1061-1068. e1. doi: 10.1016/j.jaad.2018.06.053

[29] Yelamos O, Ros S, Puig L. Improving patient outcomes in psoriasis: Strategies to ensure treatment adherence. Psoriasis (Auckl). 2015; 5:109-115. doi: 10.2147/PTT.S54070

[30] Zaghloul SS, Goodfield MJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004; 140(4):408-414. doi: 10.1001/archderm.140.4.408

[31] Bewley A, Burrage DM, Ersser SJ, Hansen M, Ward C. Identifying individual psychosocial and adherence support needs in patients with psoriasis: A multinational two-stage qualitative and quantitative study. J Eur Acad Dermatol Venereol. 2014; 28(6):763-770. doi: 10.1111/jdv.12174

[32] Bewley A, Page B. Maximizing patient adherence for optimal outcomes in psoriasis. J Eur Acad Dermatol Venereol. 2011;25Suppl 4:9-14. doi: 10.1111/j.1468-3083.2011.04060.x

[33] Ros S, Puig L, Carrascosa JM. Cumulative life course impairment: The imprint of psoriasis on the patient’s life. Actas Dermosifiliogr. 2014; 105(2):128-134. doi: 10.1016/j.ad.2013.02.009

[34] Zhu B, Jing M, Yu Q, Ge X, Yuan F, Shi L. Treatments in psoriasis: From standard pharmacotherapy to nanotechnology therapy. Postepy Dermatol Alergol. 2022; 39(3):460-471. doi: 10.5114/ada.2021.108445