Psoriasis is a chronic condition that requires continual treatment to achieve and maintain disease clearance, which can lead to a substantial treatment burden for patients. Patient treatment preferences are often not fully discussed in routine clinical practice, which can result in a lack of understanding of patient concerns and needs, as well as decreased treatment adherence when treating with biologics.

Psoriasis is a lifelong chronic disease. Therefore, we need to have good, trusting relationships with our patients so that we can be on the same page when it comes to treatment because we will be treating them throughout their lives. When a biologic agent is selected for the treatment of psoriasis, there are many patient-related factors to consider, as these drugs can vary in their US Food and Drug Administration (FDA) approvals for psoriatic arthritis and for site-specific disease, routes of delivery, dosing frequencies, mechanisms of action, efficacy, safety, and patient copayments.

I find that many of my patients with psoriasis today have a good baseline knowledge of what the disease is, what the systemic implications can be, and why effective treatment is important. Still, it is worth the time investment to explain to patients what is going on in their bodies in terms of this disease being one of systemic inflammation with cutaneous manifestations. Similar to diabetes and high blood pressure, it is a chronic systemic problem that must be treated holistically. This can help patients understand why their psoriasis may need to be treated systemically vs using just a topical medication alone. Having this discussion with patients up front can help facilitate the conversation about selecting a biologic agent and may lead to greater patient satisfaction and adherence to the selected treatment.

The next discussion should be surrounding the patient’s preferences regarding the route of medication delivery and the dosing frequency. Do they want to avoid injections altogether? If a patient prefers pills, that information is helpful for directing treatment discussions and feeling out whether they would be comfortable with taking a pill once or maybe even twice a day. If a patient is amenable to injection but wants to do so as infrequently as possible, I may turn to therapies that are dosed every 8 or 12 weeks. When addressing needle phobia specifically, it is important to note, however, that, even with some of the oral options, blood draws may still be part of the clinical picture. We need to consider that element, both in terms of the fear of needles and the ease with which a patient can access a lab regularly to get blood draws.

The location and subtype of the disease can help delineate not only the most effective treatment options but also insurance coverage. Some of the biologics are FDA approved for psoriatic arthritis and/or site-specific disease, including nail psoriasis, scalp psoriasis, inverse psoriasis, and genital psoriasis. So, a patient’s symptoms need to be properly documented to ensure coverage by the payer. In the end, the most effective and preferred treatment is the one that the patient can actually obtain.

Overall, we want to ensure optimal adherence in a practical way. Who is this patient? What is their life like? What are their daily activities and responsibilities? What are their fears? What is their comfort level with treatment? All these factors need to be considered. If they are not, I would argue that it can undermine the practitioner-patient relationship and the patient’s confidence in any treatment recommendations that are made.