Dermatologist preferences for first-line therapy of moderate to severe psoriasis in healthy adult patients

J Am Acad Dermatol. 2012 Mar;66(3):376-86. doi: 10.1016/j.jaad.2011.03.012. Epub 2011 Aug 19.


Background: Despite increasing therapies for moderate to severe psoriasis, dermatologists' treatment preferences are unknown.

Objective: We sought to assess dermatologists' preferences for first-line treatments and their selection determinants.

Methods: We surveyed 1000 US dermatologists (500 National Psoriasis Foundation and 500 American Academy of Dermatology members who treat psoriasis) about their preferences for first-line treatment of moderate to severe psoriasis in healthy adults of childbearing age using standardized patient vignettes.

Results: The response rate was 39% (N = 387). Preferred therapies for male and female patients were: ultraviolet (UV) B (40% and 56%, respectively), etanercept (15% and 19%), methotrexate (16% and 4%), and adalimumab (12% and 10%). Of respondents, 66% administered phototherapy in their practice. After adjusting for all physician characteristics, those preferring first-line UVB for male or female patients were significantly more likely to have phototherapy in their practice (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.8-6.6 and OR 2.8, 95% CI 1.5-5.3, respectively) and to have used UVB in more than 10 patients in the last 3 months (OR 8.0, 95% CI 3.9-16.4; OR 9.6, 95% CI 4.3-21.6). Dermatologists in the Midwest were more likely than those in the Northeast to prefer adalimumab first line for male and female patients.

Limitations: We surveyed only dermatologists with interest in treating psoriasis and elicited their treatment preferences for a single base case scenario. Treatment preferences may differ between survey respondents and nonrespondents.

Conclusion: UVB is most commonly preferred as a first-line treatment for moderate to severe psoriasis in healthy adults, and preferences vary based on region, phototherapy availability, and prior treatment use.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab
  • Adult
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Attitude of Health Personnel*
  • Dermatology / methods*
  • Etanercept
  • Female
  • Health Care Surveys*
  • Humans
  • Immunoglobulin G / therapeutic use
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Methotrexate / therapeutic use
  • Professional Practice
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Severity of Illness Index
  • Ultraviolet Therapy*


  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Receptors, Tumor Necrosis Factor
  • Adalimumab
  • Etanercept
  • Methotrexate