Evaluating treatment choice among patients with moderate or severe psoriasis in the United States

psoriasis


Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments • To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing • Clinical studies showed: -53% of patients reported clear/mostly clear skin within 4 months -83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year -Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to few discontinuations • Regular laboratory monitoring is not required, although pre-initiation testing may be needed • Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral psoriasis treatment • Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of the survey • A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and likelihood of initiating treatment, both (4) without a safety warning and (5)

Data collection process
• The study was reviewed and approved by an Institutional Review Board • The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to collect patient-reported data • Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) instruments and de novo questions • Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, followed by an informed consent checkbox • The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated with the choice of the new treatment among patients who were currently receiving treatment or who had never received treatment -Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body regions affected • Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing frequency) were ranked as an ordinal category (scale of 1-6) by patients • Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed • The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White (74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1) • Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 (±4.8) years (Table 2) • With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (  Group 5: Exploratorya aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in the past but were not currently receiving treatment (n = 47). TNFi, tumor necrosis factor inhibitor.  • Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) ( Table 3) • Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4) • Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicity a (B)
• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% reported that it would reduce their symptoms more than their current psoriasis treatment ( Figure 5)      -Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of respondents with moderate psoriasis and 82.8% of respondents with severe disease answering "yes" • Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new treatment was 3.2 (95% CI, 2.0-4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1-8.2) among patients with moderate psoriasis, and 7.6 (95% CI, 3.9-15.0) among patients with severe psoriasis; all P < 0.001 -79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection would start the new treatment -87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their current treatment would start the new treatment • Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked "extent of skin clearance" as first or second, while 43.7% ranked "route of administration" as first or second ( Figure 6) • Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Objectives Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments • To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing • Clinical studies showed: -53% of patients reported clear/mostly clear skin within 4 months -83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year -Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to few discontinuations • Regular laboratory monitoring is not required, although pre-initiation testing may be needed • Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral psoriasis treatment • Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of the survey • A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and likelihood of initiating treatment, both (4) without a safety warning and (5)

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated with the choice of the new treatment among patients who were currently receiving treatment or who had never received treatment -Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body regions affected Group 5: Exploratorya aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in the past but were not currently receiving treatment (n = 47). TNFi, tumor necrosis factor inhibitor.

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicity a (B)
Over-the-counter nonprescription 225 (27.5) Topical prescription steroid 230 (28.1) Topical vitamin D analog 49 (6.0) Other topical treatment 55 (6.7) • Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) ( Table 3) • Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4) • Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast • In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)     -Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of respondents with moderate psoriasis and 82.8% of respondents with severe disease answering "yes" • Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new treatment was 3.2 (95% CI, 2.0-4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1-8.2) among patients with moderate psoriasis, and 7.6 (95% CI, 3.9-15.0) among patients with severe psoriasis; all P < 0.001 -79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection would start the new treatment -87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their current treatment would start the new treatment • Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked "extent of skin clearance" as first or second, while 43.7% ranked "route of administration" as first or second (Figure 6) • Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

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Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing • Clinical studies showed: -53% of patients reported clear/mostly clear skin within 4 months -83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year -Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to few discontinuations • Regular laboratory monitoring is not required, although pre-initiation testing may be needed • Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral psoriasis treatment • Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of the survey • A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and likelihood of initiating treatment, both (4) without a safety warning and (5)

Data collection process
• The study was reviewed and approved by an Institutional Review Board • The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to collect patient-reported data • Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) instruments and de novo questions • Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, followed by an informed consent checkbox • The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated with the choice of the new treatment among patients who were currently receiving treatment or who had never received treatment -Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body regions affected • Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing frequency) were ranked as an ordinal category (scale of 1-6) by patients • Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed • The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White (74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1) • Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 (±4.8) years (Table 2) • With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe ( Table 2) A.
a Percentages sum to >   Group 5: Exploratory a a The exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in the past but were not currently receiving treatment (n = 47). TNFi, tumor necrosis factor inhibitor.      • Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicity a (B)
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) ( Table 3) • Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4) • Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast • In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Psoriasis severity over the past week (based on a 6-point scale)
-83% of Black respondents would start the new once-daily oral treatment • Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval [CI], 1.4-4.2) among Black respondents (P = 0.036) -Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of respondents with moderate psoriasis and 82.8% of respondents with severe disease answering "yes" • Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new treatment was 3.2 (95% CI, 2.0-4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1-8.2) among patients with moderate psoriasis, and 7.6 (95% CI, 3.9-15.0) among patients with severe psoriasis; all P < 0.001 -79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection would start the new treatment -87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their current treatment would start the new treatment • Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked "extent of skin clearance" as first or second, while 43.7% ranked "route of administration" as first or second (Figure 6) • Laboratory monitoring was ranked least important by more than half (53.0%) of the patients  This poster may not be reproduced without written permission from the authors.

Objectives Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments Secondary • To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments • To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing • Clinical studies showed: -53% of patients reported clear/mostly clear skin within 4 months -83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year -Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to few discontinuations • Regular laboratory monitoring is not required, although pre-initiation testing may be needed • Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral psoriasis treatment • Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of the survey • A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and likelihood of initiating treatment, both (4) without a safety warning and (5)

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed • The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White (74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1) • Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 (±4.8) years (Table 2) • With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe ( Group 5: Exploratorya aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in the past but were not currently receiving treatment (n = 47). TNFi, tumor necrosis factor inhibitor.         treatment was 3.2 (95% CI, 2.0-4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1-8.2) among patients with moderate psoriasis, and 7.6 (95% CI, 3.9-15.0) among patients with severe psoriasis; all P < 0.001 -79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection would start the new treatment -87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their current treatment would start the new treatment • Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked "extent of skin clearance" as first or second, while 43.7% ranked "route of administration" as first or second (Figure 6) • Laboratory monitoring was ranked least important by more than half (53.0%) of the patients Figure 6. Reason for treatment choice ranking