Patients are often unsure how much topical therapy to use, when to use it, and how often they should be using it .
Unpredictable flares can make patients uncertain whether topical therapies are managing symptoms .
Reported lack of support from clinicians .
Concerns about potential adverse effects .
Short-term effects (e.g. skin irritation) / Long-term effects (e.g. organ damage in biologics).
High levels of uncertainty .
Will my treatments stop working? / What will happen if they stop working?
Distress associated with therapy taking can influence adherence (33-78% of PsO patients do not use their therapy as prescribed) .
Adherence to treatment is a complex behaviour, especially for PsO and many patients report making strategic judgements about how they use topical therapies, even though not discussed with their clinician (both over and under-use).
Treatment overuse has important implications for drug side-effects.
The iMAP study surveyed 811 with moderate to severe PsO patients treated across 35 dermatology centres around England .
Non-adherence can occur with all drugs, and this study found rates of almost 30% for conventional systemic therapies and 16% for biologic therapies .
People who reported the strongest concerns about their systemic therapy were more likely to be classified as non-adherent, than those who reported weaker concerns and medication beliefs were not associated with unintentional non-adherence (e.g. forgetting) .
The most important, potentially modifiable, factors influencing adherence was found to be belief about PsO treatment and medicines in general and mood drive intentional non-adherence (see Figure 1).
People who reported weaker medication-taking habits/routines for taking their systemic therapy were more likely to be classified as non-adherent, than those who reported stronger habits/routines.
1. Thorneloe RJ, Bundy C, Griffiths CE, et al. Adherence to medication in patients with psoriasis: a systematic literature review. Br J Dermatol. 2013;168:20-31.
2. Thorneloe RJ, Bundy C, Griffiths CE, et al. Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis. Br J Dermatol. 2017;176:667-76.
3. Thorneloe RJ, Griffiths CEM, Emsley R, et al.; British Association of Dermatologists Biologic Interventions Register; Psoriasis Stratification to Optimise Relevant Therapy Study Groups. Intentional and unintentional medication non-adherence in psoriasis: The role of patients’ medication beliefs and habit strength. J Invest Dermatol. 2018;138:785-94.
With this collection of summaries from selected presentations at SPIN 2019, and interviews with international experts, we hope to share with you some of the highlights of this year’s congress. The international network met … [ Read all ]