Psoriasis/Psoriatic Arthritis Patients’ Long-term Treatment Patterns and Adherence to Systemic Treatments Monitoring Recommendations

Limited information exists regarding treatment of patients with psoriasis/psoriatic arthritis in primary care. The aim of this study is to assess treatment patterns, adherence, persistence, and compliance in newly diagnosed patients with psoriasis/psoriatic arthritis from 2012 to 2018 in Stockholm, Sweden. In addition, laboratory monitoring before initiation of treatment and at recommended intervals was quantified for patients prescribed methotrexate or biologics. A total of 51,639 individuals were included, with 39% initiating treatment with topical corticosteroids and < 5% receiving systemic treatment within 6 months post-diagnosis. During a median (interquartile range) follow-up of 7 (4–8) years, 18% of patients received systemic treatments at some point. Overall, 5-year persistence rates were 32%, 45% and 19% for methotrexate, biologics, and other systemic treatments, respectively. Pre-initiation laboratory tests, as recommended by guidelines, were performed in approximately 70% and 62% of methotrexate and biologics users, respectively. Follow-up monitoring at recommended time intervals occurred in 14–20% and 31–33% of patients prescribed methotrexate and biologics, respectively. These findings highlight gaps in the pharmacological care of patients with psoriasis/psoriatic arthritis, including suboptimal adherence/persistence and inadequate laboratory monitoring. SIGNIFICANCE This study explored treatment patterns and persistence among newly diagnosed patients with psoriasis/psoriatic arthritis (PsO/PsA). Importantly the study included patients diagnosed in primary care, enabling a more comprehensive coverage of the psoriasis population. Swedish treatment guidelines include laboratory monitoring recommendations for systemic treatment. However, the degree to which monitoring guidelines are implemented is unclear. The study highlights several shortcomings in the management of patients with psoriasis, including insufficient monitoring and inadequate treatment compliance. These findings call for both further study regarding the low compliance with monitoring recommendations and improvement in the management of patients with psoriasis to ensure better patient outcomes.