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Predictors of Biologic Use and Satisfaction Among Patients With Psoriasis: An Analysis and Geographic Visualization of the 2016 and 2017 National Psoriasis Foundation Annual Surveys

Background: There are an increasing number of biologic therapies approved for the treatment of psoriasis. Previous reports have identified undertreatment as a concern in the United States. Undertreatment has been associated with decreased patient satisfaction and increased morbidity. Objectives: Assess biologic use and satisfaction among respondents to the 2016 and 2017 National Psoriasis Foundation (NPF) Annual Surveys. Methods: Retrospective data analysis of the 2016 and 2017 NPF Annual Survey responses from individuals with psoriasis. ArcGIS Pro software was utilized to generate maps and perform an optimized hot spot analysis of moderate-to-severe psoriasis and biologic use. Results: There were 427 patients with psoriasis involving the skin alone. Biologics were used in <23% of respondents, while nearly 69% reported body surface area (BSA) >3%. Respondents with BSA <3% and 3% to 4% were less likely to be on biologic therapy (odds ratio [OR]: 0.29, 0.11-0.78 and OR: 0.22, 0.09-0.56, respectively). Nonbiologic users were more likely to be very unsatisfied with their treatment compared to those receiving biologic therapy (OR: 5.23, 2.80-9.75). With geographic information systems (GIS), counties with increased moderate-to-severe disease were identified in the southeastern United States. Conclusion: Despite the increasing number of Food and Drug Administration–approved biologic medications, the proportion of respondents on biologic therapy remained small. Treatment with biologics correlated with less residual disease and increased satisfaction. Geographic variation in state legislation as well as state and federal health insurance did not impact biologic use. However, using GIS, we identify a greater burden of moderate-to-severe disease among respondents in the Southeastern United States and a lack of commensurate use of biologics in those areas.