Frequency,Prevalence,and Burden of Flares on Patients with Moderate to Severe Psoriasis: A Retrospective Cross-Sectional Analysis

Abstract

Background

Psoriasis impairs health-related quality of life (HRQoL).

Objective

To improve understanding of flare burden in patients with moderate to severe psoriasis.

Methods

A retrospective, cross-sectional study comparing data in U.S. patients with and without psoriasis flares. Physicians identified flaring patients as those not in remission, or in remission < 12 weeks, with worsening/unstable disease progression.

Results

Overall health status (EQ-5D-3L) was reduced in flaring versus matched non-flaring patients (P = .001); this difference was clinically meaningful (> 0.074 difference in absolute value). Reduced HRQoL and activity impairment, measured by Dermatology Life Quality Index (P = .0178) and Work Productivity and Activity Impairment Questionnaire (P = .0002), respectively, were observed in flaring versus non-flaring patients. Anxiety was associated with flaring (P = .0139). Flaring patients were less satisfied with treatment effectiveness than non-flaring patients (P < .0001). The flaring group experienced a median of two flares over 12 months.

Conclusion

Flares are associated with reduced health status and HRQoL and lower treatment satisfaction.

Keywords

anxiety flare frequency patient-reported outcomes prevalence psoriasis quality of life

Get full access to this article

View all access options for this article.

References

Carey

Glazer

Gottlieb

A.B.

Relapse, rebound, and psoriasis adverse events: an advisory group report.

J Am Acad Dermatol. 2006; 54: S171–S181.

Kimball

A.B.

Jacobson

Weiss

Vreeland

M.G.

. The psychosocial burden of psoriasis. Am J Clin Dermatol. 2005; 6: 383–392.

Kurd

S.K.

Troxel

A.B.

Crits-Christoph

Gelfand

J.M.

. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146: 891–895.

Langley

R.G.

Krueger

G.G.

Griffiths

C.E.

. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005; 64: ii18–ii23.

Reich

Hrehorów

Szepietowski

J.C.

. Pruritus is an important factor negatively influencing the well-being of psoriatic patients. Acta Derm Venereol. 2010; 90: 257–263.

Armstrong

A.W.

Schupp

Bebo

. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011. PLoS One. 2012; 7: e52935.

Augustin

Radtke

M.A.

. Quality of life in psoriasis patients. Expert Rev Pharmacoecon Outcomes Res. 2014; 14: 559–568.

Anderson

Benford

Harris

Karavali

Piercy

. Real-world physician and patient behaviour across countries: Disease-Specific Programmes - a means to understand. Curr Med Res Opin. 2008; 24: 3063–3072.

EuroQoL Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16: 199–208.

10.

Finlay

A.Y.

Khan

G.K.

. Dermatology Life Quality Index (DLQI) — a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19: 210–216.

11.

Reilly

M.C.

Zbrozek

A.S.

Dukes

E.M.

. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993; 4: 353–365.

12.

Normand

S.T.

Landrum

M.B.

Guadagnoli

Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores.

J Clin Epidemiol. 2001; 54: 387–398.

13.

Austin

P.C.

. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res. 2011; 46: 399–424.

14.

Abadie

Imbens

G.W.

. Matching on the Estimated Propensity Score. Econometrica. 2016; 84: 781–807.

15.

Keele

. An overview of rbounds: An R package for Rosenbaum bounds sensitivity analysis with matched data. Available at: http://www.personal.psu.edu/ljk20/rbounds%20vignette.pdf. Last updated 20 August 2010. Accessed 13 August 2016.

16.

Walters

S.J.

Brazier

J.E.

. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005; 14: 1523–1532.

17.

Korman

N.J.

Zhao

Liao

Tran

M.H.

. Clinical symptoms and self-reported disease severity among patients with psoriasis — Implications for psoriasis management. J Dermatolog Treat. 2015; 26: 514–519.

18.

Jones

J.D.

Hass

Mangal

Lafo

Okun

M.S.

Bowers

. The cognition and emotional well-being indices of the Parkinson's disease questionnaire-39: what do they really measure? Parkinsonism Relat Disord. 2014; 20: 1236–1241.

19.

Orgeta

Edwards

R.T.

Hounsome

Orrell

Woods

. The use of the EQ-5D as a measure of health-related quality of life in people with dementia and their carers. Qual Life Res. 2015; 24: 315–324.

20.

Sturm

J.W.

Donnan

G.A.

Dewey

H.M.

Quality of life after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS).

Stroke. 2004; 35: 2340–2345.

21.

Korman

N.J.

Zhao

Roberts

Impact of psoriasis flare and remission on quality of life and work productivity: a real-world study in the USA.

Dermatol Online J. 2016; 22(7).