Study Outlines Patient-Reported Outcomes Among Pediatric Patients With Psoriasis

New research describes patient-reported outcomes and disease burden among pediatric patients with psoriasis in the United States, United Kingdom, France, Germany, Spain, and Italy.

The condition affects 2% to 4% of individuals in western countries, researchers wrote in Acta Dermato-Venereologica, while around one quarter of patients experience disease onset prior to adulthood.

“Pediatric psoriasis (onset < 18 years) is associated with a substantial negative effect on quality of life and patients have a greater risk of developing psychosocial disorders compared with those without psoriasis,” the authors explained.

In addition, “due to the visibility of psoriatic plaques, pediatric patients with psoriasis experience social discomfort, bullying, and stigma.”

Their current analysis of a cross-sectional survey included responses from dermatologists, general practitioners or primary care practitioners, and pediatricians actively managing pediatric patients with psoriasis.

Patients aged 12 to 17 years were also invited to complete a voluntary questionnaire. A total of 324 treating physicians were included in the study, 187 of whom were dermatologists; 71, general practitioners or primary care practitioners; and 66, pediatricians.

These physicians completed 2877 patient record forms, each representing 1 pediatric patient. Those with a treatment time of less than 4 weeks for topical therapy and/or less than 12 weeks for conventional systemic and/or biologic therapy were excluded.

Of the 2379 remaining patients, the mean age was approximately 13 years and 53% were male.

“Patient-reported data were collected for 42.7% of the analyzed population, 65.5% via the patient self-completed questionnaire (PSC) and 34.5% via the carer self-completed questionnaire (CSC). For the present analysis, physician-reported data (via patient record forms) were included only for those patients with corresponding patient-reported data (ie, a matched dataset, n = 1017),” the authors wrote.

In the matched dataset, 79.8% of all patients had mild disease, 18.2% had moderate disease and 2% had severe disease.

Analyses revealed:

• Patients with moderate to severe disease experienced the greatest impact on quality of life
• When asked about the frequency of psoriasis-related itching, overall, 27.4% and 34.6% of patients and carers, respectively, reported patients being affected “sometimes, usually, or all of the time” in the previous week
• The proportion of patients affected by itch “sometimes, usually, or all of the time” was substantially greater in patients with moderate (63.6%, PSC; 64.1%, CSC) or severe (75.0%, PSC; 57.1%, CSC) disease
• A large proportion of patients with moderate (29.6%, PSC; 35.0%, CSC) or severe (72.7%, CSC; 66.7%, CSC) psoriasis reported that itch affected their sleep “quite a bit, a lot, or a huge amount”
• The effect of psoriasis on quality of life of patients was generally greater in patients from the 5 European countries vs the United States
• Levels of treatment dissatisfaction were moderate and similarly reported between physicians, patients, and carers (22.6%, 25.5%, and 33.6%, respectively)

Data also showed that patients with mild forms of the disease had the highest level of treatment satisfaction, while greater proportions of patients with moderate or severe disease were dissatisfied with their treatment. The main reason for treatment dissatisfaction was a lack of clear skin.

The mean Children’s Dermatology Life Quality Index (CDLQI) scores were around 5 despite 80% of patients reporting mild disease, the study authors wrote, with scores substantially higher in those with more severe disease.

“The current study showed that patients frequently experienced itch, with greater severity of itching in patients with more severe psoriasis. Furthermore, itch impacted school, sleep, and physical and social activities, and itch severity correlated with CDLQI,” they added.

The subjective, physician-judged severity assessments included mark potential limitations of the study.

Overall, “management of pediatric psoriasis should consider the impact of disease on health-related QoL, patient perceptions on treatment satisfaction, and treatment goals,” researchers concluded.

Reference

Seyger MMB, Paller AS, Sticherling M, et al. Patient-reported outcomes and burden of disease in pediatric patients with psoriasis: real-world data from EU5 and US. Acta Derm Venereo. Published online April 19, 2023. doi:10.2340/actadv.v103.2544