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The Challenges of Sticking with Topical Treatments

Topical treatments are one of the most common types of medications used to treat plaque psoriasis. Topical treatments can be effective – when they are used as directed. However, many people find it challenging to stick with their topical treatment regimen, and the lack of adherence is a major cause of the continued presence of psoriasis plaques.1

Treatment adherence

Most cases of psoriasis can be effectively treated with topical treatments, but treatment adherence is a major challenge. Adherence is a combination of compliance (using the medication as instructed) and persistence (continuing to use the medication over a length of time). While many people with psoriasis agree their disease has a significant impact on their quality of life, studies have found that many patients do not follow their physicians’ recommended treatment plans.1

Studying long-term adherence in people with psoriasis

Recently, a journal article was published detailing a 12-month study of people with psoriasis and their use of topical treatments. In addition, the study evaluated the use of an internet-based reporting tool aimed at improving adherence and treatment outcomes.1

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The study included 40 adults with mild to moderate psoriasis who were prescribed topical fluocinonide. Twenty of the initial subjects completed the entire 12-month trial, with the other 20 withdrawing due to worsening psoriasis or needing to switch to another medication. Half of the patients were randomly assigned to a standard-of-care group, while the other half also participated in the internet-based reporting system. All subjects in the study were given the topical fluocinonide with the instructions to apply it twice daily (excluding areas where fluocinonide should not be used, like face, underarms, and genitals). Adherence was measured using jars of medication that had electronic monitors in the caps, however, the patients were not aware the jars had monitoring devices. Patients were asked to bring in the jars to be weighed at each visit and told medication could be refilled whenever they ran out.1

Over the course of the year, patients were scheduled for follow-up visits at 1 month, 3, 6, and 12 months. At each visit, healthcare staff evaluated the patients’ psoriasis, any possible side effects they were experiencing, and the data from the jars was downloaded.1

  • The standard of care group - In the standard-of-care group (the control group), adherence was low. In the first month, no medication was used on 37.4% of the days, and over the last month, no medication was used on 50.9% of the days. These low levels of adherence weren’t due to psoriasis clearing, as missed doses were common even in patients who still had active psoriasis.1
  • The internet-based reporting group - The internet-based reporting system improved adherence. Overall, 35% of the prescribed number of doses were taken by the control group and 50% for the group who participated in the internet-based reporting system. While patients in the internet survey group had higher adherence overall, both groups experienced less adherence over time.1

Importance of adherence

Experts estimate that nearly 50% of people with chronic diseases do not take their medications regularly, and adherence rates for topical treatments are generally lower than for systemic treatments. Poor adherence leads to poor treatment outcomes, and adherence is critical for the successful management of psoriasis.1

This recent study highlights the challenges of adherence to topical treatments. 100% of the subjects did not take their medication as directed, and the recommended dose was only taken on 15% of the observed study days. Still, the study authors admit that the adherence is likely even lower in real-life patients who are not in a clinical trial setting.1

Healthcare professionals continue to search for ways to help patients with treatment adherence, including strengthening the physician-patient relationship, choosing treatments that patients are willing to use, giving written instructions, providing detailed education, and scheduling follow-ups.1

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