Use of biologics, systemic corticosteroids to treat psoriasis, psoriatic arthritis increases

The use of biologic therapy to treat psoriasis and psoriatic arthritis has increased over time along with the use of systemic corticosteroids, according to a letter published in the Journal of the American Academy of Dermatology.

“There are two major findings overall,” Jonathan I. Silverberg, MD, MPH, PhD, of the department of dermatology at George Washington University School of Medicine and Health Sciences in Washington, told Healio. “Treatment patterns for psoriasis have changed over time. On one hand, biologic use has increased over time. On the other hand, oral immunosuppressant use did not decrease over time. The second main finding was that systemic corticosteroid use did not decrease over time. In fact, use of systemic steroids numerically increased over time, despite being frowned upon in most guidelines.”

Researchers analyzed the 2001 to 2015 National Ambulatory Medical Care Survey, a cross-sectional, representative sample of U.S. office-based physician visits, for psoriasis visits. Trends in treatment utilization were assessed over 5-year intervals using logistic regression.

A weighted total of 33,600,000 psoriasis visits (95.7% in adults, 49.6% in female patients, 89.7% in metropolitan areas) occurred between 2001 and 2015. Systemic therapy was used in 20.9% of visits, most commonly with biologics (8%), followed by oral immunosuppressants (5%), systemic corticosteroids (3.5%) and phototherapy (3.3%).

Biologic therapy visits increased from 3.8% to 13.1%, particularly among dermatologists (4.1% to 12%) and patients who were privately insured (4.8% to 17.3%), who were in metropolitan areas (4.1% to 12%) and who had psoriatic arthritis (19.1% to 27.6%).

“The results demonstrate that biologics have emerged as the preferred systemic therapy in psoriasis. However, there were subsets of psoriasis patients who did not experience increased use of biologics, namely those who had public insurance and lived in non-metropolitan areas,” Silverberg said. “These results highlight that there are potential disparities of access to biologics in psoriasis.”

Systemic corticosteroid use in metropolitan areas increased from 1.7% to 5.6%. Systemic corticosteroids are not included in U.S. or European psoriasis treatment guidelines, and they are not recommended for chronic management of psoriatic arthritis. The increasing use of systemic corticosteroids in the chronic management of psoriasis and psoriatic arthritis shows important practice management gaps that suggest intervention.

“Systemic corticosteroids have poor safety and tolerability with both short- and long-term use. Short-term use with systemic steroids runs the risk of rebound flaring and destabilizing psoriasis,” Silverberg said. “Nonsteroidal alternatives should be considered wherever possible.” – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.