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Patients, dermatologists differ in perception of patient’s psoriasis

Recently published data revealed that the perceptions of patients with psoriasis differ from their dermatologists regarding disease severity, symptoms and happiness with the level of disease control.

In a retrospective study, Christopher E.M. Griffiths, MD, of the University of Manchester in England, and colleagues evaluated data acquired from the Growth from Knowledge (GfK) Disease Atlas global real-world evidence program. GfK is a syndicated, retrospective, cross-sectional survey of dermatologists (n = 524) and their systemic treatment eligible patients with psoriasis (n = 3,821; average age, 45.1 years; 56% men) across Germany, the United Kingdom, France, Spain, Italy, South Korea, Brazil, Mexico and Russia.

Griffiths and colleagues evaluated patient-dermatologist concordance for severity of disease at diagnosis and at the time of the survey, presence/severity of symptoms and satisfaction with the level of overall psoriasis control attained. They determined concordance using identical survey questions given to both patients and dermatologists. For each survey question, researchers paired the answers from patients and their dermatologists. They considered a patient-dermatologist pair concordant if the patient and dermatologist submitted identical answers, and discordant if the answers differed.

The researchers used the Cohen’s kappa statistic (K) to evaluate the agreement between the patient and dermatologist survey responses.

At the time of the survey, the mean Psoriasis Area and Severity Index (PASI) score was 6.4. Anxiety was present in 16% (n = 624) of patients and depression was present in 14% (n = 539). Most patients (59%; n = 2,226) received treatment with systemic therapy in monotherapy or combination therapy, and another 39% (n = 1,491) underwent treatment only with topical agents (with or without phototherapy).

There was a fair level of patient-dermatologist concordance regarding psoriasis severity at the time of diagnosis (K = 0.326; 61% agreement) and at the time of the survey (K = 0.37; 55% agreement). Researchers observed a greater patient-dermatologist concordance when patients categorized their disease as moderate-to-severe vs. clear/almost clear or mild.

Regarding presence of symptoms, there was a fair-to-moderate level of patient-dermatologist concordance, ranging from 0.241 for bleeding to 0.575 for joint pain. The data also demonstrated moderate concordance for itching (K = 0.422), nail pitting (K = 0.462) and skin pain (K = 0.467). The rate of patient-dermatologist agreement ranged from 68% for scaling and flaking and 92% for bleeding, onycholysis and joint pain.

Patient-dermatologist concordance for satisfaction with psoriasis control was fair (K = 0.213; 39% agreement). Additionally, the percentage of dermatologists who agreed with patients on satisfaction with disease control increased in proportion to the patient’s satisfaction. Concordance ranged from 6% to 14% when patients graded their satisfaction from 1 (not at all satisfied) to 3 and ranged from 32% to 47% when patients rated satisfaction from 4 to 7 (extremely satisfied).

Compared with other countries, South Korea had the lowest level of concordance for all factors assessed.

“This real-world survey reveals the different perceptions of patients and their dermatologists with respect to patient’s disease severity, symptoms and satisfaction with the level of psoriasis control achieved,” Griffiths and colleagues wrote. “These findings highlight the need to further incorporate patient-centered and country-specific strategies in treatment decision-making and pave the way for further research to identify the drivers of patient-dermatologist concordance.”– by Jennifer Byrne

Disclosure: Griffiths reports serving as an advisor to, and receiving research grants from, AbbVie, Actelion, Bristol Myers-Squibb, Clarins, DSM, Eli Lilly, Galderma, GlaxoSmithKline Janssen, Leo Pharma, L’Oreal, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche Sandoz, UCB Pharma and Walgreens Boots Alliance. Please see the full study for a list of all other researchers’ relevant financial disclosures.