1. A multidimensional assessment of the burden of psoriasis: Results from a multinational dermatologist and patient survey
C.E.M. Griffiths1, S.J. Jo2, L. Naldi3, R. Romiti4, E. Guevara-Sangines5, T. Howe6, G. Pietri7, I. Gilloteau8,
C. Richardson8, H. Tian9, M. Augustin10
Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK;
Department of Dermatology, Seoul National University Hospital, Seoul, Korea;
Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy;
Department of Dermatology, Hospital das Clínicas, University of São Paulo (USP), Brazil;
Hospital Regional "Lic. Adolfo López Mateos" ISSSTE México City, Mexico;
GfK, London, UK;
Data Pyxis Ltd., St Albans, UK
Novartis Pharma AG, Basel, Switzerland;
Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States;
University Medical Centre Hamburg, Hamburg, Germany
British Journal of Dermatology. DOI: /bjd.16332

2. Introduction: What’s already known about this topic?
Psoriasis is a chronic, immune-mediated inflammatory disease which causes great physical, emotional and social burden
Psoriasis is associated with a higher risk of physical and psychological comorbidities; along with bothersome symptoms such as itch and the presence of psoriatic lesions on visible and sensitive body areas
The presence of associated comorbidities, itch and lesions on visible and sensitive body areas in psoriasis patients are closely related to decreased psychosocial well-being and impact on quality of life

3. Objective
In this large and multinational real-world survey, we aimed to investigate the incremental burden of:
physical and psychological comorbidities (cardiovascular disease [CVD], psoriatic arthritis [PsA], obesity, type II diabetes [T2D] and anxiety or depression),
itch, and
presence of psoriatic lesions on visible and sensitive body areas
among systemic therapy eligible psoriasis patients compared to those without these conditions

4. Methods
Data source: Growth from Knowledge (GfK) Disease Atlas global real-world evidence programme in psoriasis
Survey conducted in 9 countries: Brazil, France, Germany, Italy, Mexico, Russia, Spain, South Korea, and the United Kingdom [UK]
Duration: From September 2015 to January 2016
Enrolled patients had or ever had moderate-to-severe psoriasis as reported by their dermatologists, and must have been receiving prescription treatments at the time of the survey
The survey captured patient data through online patient record forms (PRFs) completed by the dermatologist, and a paper survey completed by patients at the end of the consultation for collection of patient-reported outcomes (PROs) data
Statistical analyses: Multivariable generalised linear regression models with appropriate statistical distributions and link functions were developed in each psoriasis patient subgroup to assess the incremental impact of comorbidities, itch and the type of body areas affected, on psoriasis symptoms, quality of life (QoL) measures, percentage of overall work impairment and medical resource utilisation

5. Overall, 524 dermatologists and 3,821 psoriasis patients from 9 countries participated in this survey - Incremental impact of psoriasis was studied in following subgroups
Subpopulation
Comparative analyses
Presence of physical and psychological comorbidities
Comparing psoriasis patients with comorbidity with those without comorbidity (e.g. psoriasis patients with CVD vs without CVD)
Presence and extent/ severity of itch
Patients with itch at the time of the survey vs. those without itch
Outcomes by severity of itch (among patients with itch at the time of the survey), were measured on a 10-point numerical rating scale (NRS) ranging from 1 (almost no itch) to 10 (worst imaginable itch)
Localisation of plaques in body
Patients affected by psoriasis on visible body areas** in addition to non-visible areas vs. patients affected on non-visible body areas only
Patients affected by psoriasis on sensitive body areas** in addition to non- sensitive areas vs. patients affected on non-sensitive body areas only
Source: Psoriasis association Types of psoriasis. [ONLINE] Available at: [Accessed 15 February 2016].
* CVD: cardiovascular disease (inclusive of myocardial infarction, peripheral vascular disease, cerebral vascular disease and other cardiovascular disease/s);
** Visible body areas were defined as body areas not covered by clothing and therefore visible to the patient’s entourage; sensitive body areas were defined as body areas where the skin is thinner and may be more sensitive to treatment (Psoriasis Association definition); PsA: Psoriatic arthritis.

6. Adjusted % difference in percentage of overall work impairment
Psoriasis patients with comorbidities experienced worse QoL and greater work impairment than patients without comorbidities
-6.4 [-8.8; -4.1]***
-5.0 [-6.2; -3.9]***
-3.0 [-4.8; -1.2]**
-2.8 [-4.7; -0.9]**
-3.2 [-4.4; -2.0]***
SF-12 Physical Score
SF-12 Mental Score
Adjusted % difference in percentage of overall work impairment * **
DLQI Score
* p<0.05; ** p<0.01; *** p<0.0001
SF-12 Physical and Mental scores (range from 0 [maximum QoL impairment] to 100 [no QoL impairment]);
DLQI Scores (range from 0 [no QoL impairment] to 30 [maximum QoL impairment]).

7. Association between presence of itch and QoL
Presence and greater severity of itch was associated with significant decrease in QoL and work productivity
-1.5 [-2.3; -0.7]**
-1.4 [-2.3; -0.5]**
1.3 [0.7; 1.9]***
Association between presence of itch and QoL
Association between severity of itch and QoL
Adjusted % difference in percentage of overall work impairment *
***
* p<0.05; ** p<0.01; *** p<0.0001

8. Psoriasis patients with lesions on visible and sensitive skin areas were more likely to have decreased QoL and increase in medical resource use
Association between visible body areas and QoL
Association between sensitive body areas and QoL
Adjusted % difference in number of psoriasis consultations
***
* p<0.05; ** p<0.01; *** p<0.0001

9. What does this study add?
Results suggest that the clinical, humanistic and economic burden of psoriasis is complex and multidimensional, and not just determined by the severity of disease
Multiple aspects of psoriasis such as associated physical and psychological comorbidities, itch and type of body areas affected by psoriasis contribute to increase this burden further

10. Conclusion
Psoriasis patients with physical and psychological comorbidities, itch and, affected visible and sensitive body areas had lower QoL, and greater work impairment compared to those without these conditions.
Further research using longitudinal data will help to confirm these findings and to define and tailor patient-centric care programmes for psoriasis.

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