Evaluation of adherence predictors for the treatment of moderate to severe psoriasis with biologics: the importance of physician-patient interaction and communication.

Abstract

Treatment efficacy of biologic agents in moderate to severe psoriasis is regarded as high with patient adherence being higher than for traditional therapies. However, use of biologics is connected to high discontinuation rates. The current investigator-initiated study was conducted to improve the understanding of adherence. The study was designed as non-interventional retrospective multicentre trial in Germany. Questionnaires were developed based on the adherence dimensions identified by the World Health Organization, WHO. Thirteen dermatologists and 246 patients participated in the study and replied to the questionnaires. Study data were analysed for potential predictors of adherence in an explorative manner. Based on the physician's assessment of the patients' individual adherence, subsets of adherent and non-adherent patients were discriminated. Two main drivers were identified on the patients' side that were positively connected to adherence: a lack of efficacy of the previous treatments and the knowledge of comorbidities associated with severe psoriasis. Furthermore, physician-patient communication seems to play a central role, as on the dermatologists' side, there was a strong association of adherence and positive personal interrelation between dermatologist and patient. The data reported here underline the importance of patient education and information delivery to optimize patient adherence and thereby treatment outcomes. Treating physicians should be aware that soft aspects of their interaction with the patient might influence treatment adherence.