Treatment practices for psoriasis and how they are changing

To the Editor: Psoriasis is a chronic inflammatory disorder for which many new treatments are available. The purpose of this study was to assess how treatment psoriasis has been changing from 2007 through 2016. National Ambulatory Medical Care Survey (NAMCS) cross-sectional survey visits nonfederal, ambulatory-based US physicians.1Centers For Disease Control and PreventionNational Survey.ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NAMCSDate: 2016Google Scholar We assessed prescribed at with International Classification Diseases, Ninth Edition code 696.1 or 10th edition L40.9 listed among 5 leading diagnoses.22014 micro-data file documentation.https://data.nber.org/namcs/docs/namcs2014.pdfGoogle Data were analyzed by using SAS University (SAS Institute, Cary, NC). correct multiple hypothesis tests performed, standard alpha value .05 reduced .005 Bonferroni correction.3Leon A.C. Multiplicity-adjusted sample size requirements: strategy maintain statistical power adjustments.J Clin Psychiatry. 2004; 65: 1511-1514Crossref PubMed Scopus (31) Google There 935 visits, representing 23.2 (95% confidence interval [CI], 21.8-24.7) million visits. 12.1 CI, 10.7-13.4) female patients, 51.9% 46.1-57.7) total. most common race white (68.9%; 95% 63.4-74.4). 2.32 per year no change in visit frequency an increase (P = .2). Topical medications about half all (Fig 1). use topical agents decreased < .001) estimated 0.23% 0.16-0.30) (Table I Fig also decrease corticosteroids vitamin D analogs but not calcineurin inhibitors .04). represented 75% 68-82) observed, 28% 26-30), 7.1% 5.4-8.5).Table IOdds ratios modalities based on 1-year intervalTreatment typeOdds ratio CI)Topical overall0.87 (0.83-0.91)∗Indicates P .05.Topical corticosteroids0.90 (0.86-0.95)∗Indicates analog0.75 (0.66-0.85)∗Indicates inhibitor0.86 (0.74-0.99)∗Indicates .05.Systemic corticosteroids0.89 (0.77-1.0)∗Indicates .05.Adalimumab1.3 (1.0-1.6)∗Indicates .05.Infliximab1.9 (1.1-3.3)∗Indicates .05.Etanercept0.9 (0.76-1.1)Ustekinumab0.79 (0.48-1.3)Secukinumab—Acitretin0.95 (0.70-1.3)Apremilast1.4 (0.04-53)Cyclosporine0.76 (0.58-0.99)∗Indicates .05.Methotrexate0.92 (0.80-1.1)Phototherapy.92 (0.78-1.2)CI, Confidence interval.∗ Indicates .05. Open table tab interval. Systemic quarter Biologics 12% 9.7-14) psoriasis, systemic 5.4-8.8) other small molecule drugs 8.6% 7.1-10). 1% 2% adalimumab infliximab .03), significant after correcting multiplicity. fewer over time cyclosporine etanercept .2), ustekinumab .3), acitretin .8), apremilast .9), .7) used. Phototherapy fraction 1), there .3). A limitation that estimating changes required unassigning reassigning weighting variable. Therefore, these estimates more useful their directionality magnitude as detailed high accuracy. Because 7.4 people United States have psoriasis,4Rachakonda T.D. Schupp C.W. Armstrong A.W. prevalence adults States.J Am Acad Dermatol. 2014; 70: 512-516Abstract Full Text PDF (480) patients do seek ambulatory care given year. Since mild disease,5Stern R.S. Nijsten T. Feldman S.R. Margolis D.J. Rolstad common, carries substantial burden even when extensive, associated widespread dissatisfaction.J Investig Dermatol Symp Proc. 9: 136-139Abstract (573) our supports finding disease treatment. commonly used treatments; however, decreasing modestly, whereas biologic increasing. As become available, we expect trends may continue past end time. corticosteroid phototherapy continues be infrequent perhaps underused Trends differ established patientsJournal American Academy DermatologyVol. 85Issue 1PreviewTo read interest article Muddasani et al,1 “Treatment practices they changing,” investigated data authors found biologics, decline therapy use, phototherapy, acitretin, use. In study, “Trends 2005 2018: Declining utilization concomitant increased biologics,” conducted large New York City academic center between 2018, identified some similar trends. Full-Text