Topical therapies fall short of patient expectations during psoriasis treatment

Once-daily halobetasol propionate 0.01% and tazarotene 0.045% fixed-combination lotion stands out as a favorable treatment option amid topical therapies deemed unsatisfactory by psoriasis patients, according to a systematic review.

In 2018, the National Psoriasis Foundation survey reported that out of 314 individuals with psoriasis, 87.1% were using topical therapies; however, only 13.6% were satisfied with their current treatment. Of those dissatisfied with topical treatments, 74.8% attributed their dissatisfaction to ineffectiveness.

“Studies have suggested discordance between physician and patient reported treatment outcomes owing to misalignment of physician perceptions with patient preferences regarding treatment satisfaction,” James Del Rosso, DO, adjunct clinical professor of dermatology at Touro University Nevada College of Osteopathic Medicine in Henderson, Nevada, and colleagues wrote. “Understanding discrepancies in patient and provider expectations can help in recognizing shortcomings of prescribed topical treatments.”

In this review, Del Rosso and colleagues evaluated surveys and studies to determine how current topical treatments meet patient expectations, giving particular attention to combination regimens using corticosteroids.

Researchers found that patients attribute satisfaction and effectiveness to skin clearance, symptom relief and ease of use. A real-world study of 304 patients confirmed that topical therapies have not met these parameters of satisfaction and effectiveness.

In one study, the researchers found that more than 20% of patients reported the use of more than two different topicals to treat their psoriasis. Many were left with residual scaling, erythema, itching and pain, with only 15% of patients achieving at least 75% reduction in body surface area involvement.

Nevertheless, studies continue to show that patients prefer topical treatments, according to the researchers. In a 2018 survey, 54.3% of 92 participants on systemic or biologic treatment that had previously used topical treatments said they would have preferred to continue topical use had it been effective.

Patients may prefer topical treatments because they are “perceived as safer than systemic therapies,” the researchers wrote, adding that this illustrates “a need for topical therapy that not only achieves objective measures of treatment success but also meets patient expectations.”

The authors suggest that halobetasol propionate 0.01% and tazarotene 0.045% lotion (HP/TAZ), applied once daily, bridges the gap between effectiveness and patient expectations.

In a phase 3 trial evaluating the long-term efficacy of HP/TAZ, improvement was observed within 2 weeks, which may encourage patients to comply with treatment adherence. Furthermore, in a 52-week multicenter, open-label study, treatment success was achieved in 57.8% of study participants, with 54.4% achieving it within 8 weeks.

The combination of the two active ingredients minimized the corticosteroid-related adverse events while also achieving results that patients expect, according to the researchers.

“Psoriasis treatment is more successful and promotes therapy adherence when patients perceive it as tolerable and effective,” Del Rosso and colleagues wrote. “Evidence suggests that the efficacy, tolerability, and safety profiles of fixed-combination HP/TAZ lotion may optimize treatment adherence, leading to a greater likelihood of disease improvement and skin clearance.”