Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis

J Am Acad Dermatol. 2013 Jan;68(1):64-72. doi: 10.1016/j.jaad.2012.06.035. Epub 2012 Jul 28.


Background: Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood.

Objectives: We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice.

Methods: A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments.

Results: A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95% confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72).

Limitations: The study is limited by its reliance on patient recall.

Conclusions: Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acitretin / therapeutic use
  • Adalimumab
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Cross-Sectional Studies
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Keratolytic Agents / therapeutic use
  • Logistic Models
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • PUVA Therapy / adverse effects
  • PUVA Therapy / economics
  • Patient Satisfaction*
  • Psoriasis / drug therapy*
  • Psoriasis / radiotherapy*
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Surveys and Questionnaires
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Keratolytic Agents
  • Receptors, Tumor Necrosis Factor
  • Adalimumab
  • Acitretin
  • Etanercept
  • Methotrexate