Treatment Preferences in Young Adults with Moderate to Severe Psoriasis: A Qualitative Study from the Nordic Countries

Abstract

Introduction The purpose of this study is to explore treatment preferences and identify patient characteristics in young bio-naive adults with moderate to severe psoriasis in the Nordic countries (Norway, Finland, Sweden, and Denmark). Methods Patients were 18–45 years old and bio-naive but referred for biologic treatment of moderate to severe psoriasis. Patients were included at eight Nordic dermatology clinics. Patients with significant comorbidity or psoriatic arthritis were excluded. The Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were assessed along with basic patient information. A semistructured interview guide was used in individual qualitative interviews, asking patients about their treatment preferences and reasons, disease journey, and disease management. The interviews were analyzed using thematic content analysis. Twenty-four patients sufficed to reach saturation in this qualitative study. Results The patient sample characteristics represented a qualitative variation in age, sex, symptoms, duration of disease, and country. We included a total of 12 male and 12 female patients. The mean age was 34 years (range 18–45 years), the mean age at diagnosis was 20 years (range 6–34 years), the mean ± standard deviation (SD) time since diagnosis was 13 ± 8 years, PASI was 9.5 ± 4.7, and DLQI was 15.2 ± 6.4. Interviews suggested that both the burden of disease as well as the burden of treatment influenced patient preferences regarding treatment attributes, hence getting alleviation from symptoms did not alone influence patient preferences. Time, effort, and inconvenience related to psoriasis treatments also influenced patient preferences. Conclusions This first in-depth, qualitative study in young bio-naive adults with psoriasis suggests that patient preferences are focusing not only on symptom relief but also on alleviating the burden of psoriasis treatment. Understanding the reasons for patient preferences and the perspectives of young adults is needed to guide individual shared decision-making in psoriasis management. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-023-00973-5.

Aging Impact in Response to Different Classes of Biological Treatment in Psoriatic Patients: A Real-Life Observational Study

“…Interestingly, anti-IL17 drugs were more frequently prescribed for older individuals, while anti-IL23 drugs were more prevalent in younger demographics. This preference could reflect the desire for better treatment adherence and potential disease-modifying effects offered by anti-IL23 agents [24,25]. Additionally, the preference for treatments requiring fewer injections per year could influence the choice of anti-IL23 drugs, especially among younger, actively employed patients [24].…”

“…This preference could reflect the desire for better treatment adherence and potential disease-modifying effects offered by anti-IL23 agents [24,25]. Additionally, the preference for treatments requiring fewer injections per year could influence the choice of anti-IL23 drugs, especially among younger, actively employed patients [24]. Furthermore, the selection of specific monoclonal drugs also exhibited variations within each age group, with certain drugs being administered more frequently based on specific age categories.…”

“…However, in the group of patients under 26 years old, the greater speed of action of IL-17 was not statistically significant due to the limited sample size (n = 15) of patients treated with anti-IL17 in this age group. The lower number of young patients treated with anti-IL17 was primarily due to clinical choice, as the more convenient administration of anti-IL23 better suited the dynamic lifestyle of the younger population compared to adults [24,28].…”

“…In conclusion, our study has demonstrated that chronological age is not a critical factor in the selection of monoclonal drugs for psoriasis treatment. However, considering age and its associated social factors (such as lifestyle dynamics) and comorbidities [14] can be of significant utility in the clinical decision-making process [24]. This is particularly relevant when choosing between an anti-IL17 or anti-IL23 drug, as it can enhance patient compliance and contribute to improved clinical outcomes and quality of life [21,24].…”

NLRP3 (rs10754558) gene polymorphism and tumor necrosis factor alpha as predictors for disease activity and response to methotrexate and adalimumab in psoriasis

“…Various therapies exhibit different levels of effectiveness, safety, speed of response, and long-term response sustainability. They also differ in terms of treatment administration processes, including frequency, duration, and convenience, as well as treatment costs [ 6 ]. Referral to a dermatologist may be necessary for the examination and the use of systemic therapy in cases that are more severe and resistant [ 7 ].…”