Satisfaction and Awareness of Systemic Psoriasis Treatments: A National Survey Comparing Biologic and Nonbiologic Users

J Cutan Med Surg. Mar/Apr 2019;23(2):148-156. doi: 10.1177/1203475418808764. Epub 2019 Feb 25.


Background:: There is ongoing development of new therapies for psoriasis, including biologic and systemic agents such as interleukin-17, interleukin-23, and phosphodiesterase-4 inhibitors. The development of these agents has changed the landscape of psoriasis treatment options.

Objective:: The objective of this study was to characterize the impact of newer biologic and systemic agents approved by June 2016 on patient outcomes. We sought to evaluate and compare biologic users and nonbiologic systemic users with respect to their treatment awareness and satisfaction.

Methods:: We conducted a national Canadian survey from July to September 2016 on adult patients with moderate-to-severe psoriasis using biologic agents or nonbiologic systemic agents as their current primary treatment modality. Patients were asked to evaluate their overall satisfaction with their treatment agent and their awareness of other treatment options. Responses from biologic and nonbiologic systemic users were compared.

Results:: Overall, 343 participants were included (biologic users: n = 218; nonbiologic users: n = 125). Treatment satisfaction: Biologic users had a higher overall satisfaction score than nonbiologic users ( P < .001). Among nonbiologic agents, apremilast (62%) was associated with the highest satisfaction proportion. Among biologic agents, ustekinumab (77%) and adalimumab (72%) were associated with the highest proportions of satisfaction. With respect to treatment awareness, 30% of nonbiologic patients did not have enough information to form an opinion about biologics.

Conclusions:: This study demonstrates the greater treatment satisfaction of biologic users compared with nonbiologic users for moderate-to-severe psoriasis. Given that nearly one-third of nonbiologic users did not have enough information to form an opinion about biologic agents, physicians may consider counselling these patients on the use of biologic agents for psoriasis management.

Keywords: biologics; psoriasis; satisfaction; systemics; treatment.

MeSH terms

  • Adalimumab / therapeutic use
  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Biological Products / therapeutic use*
  • Canada
  • Cyclosporine / therapeutic use
  • Dermatologic Agents / therapeutic use*
  • Etanercept / therapeutic use
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infliximab / therapeutic use
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Patient Satisfaction*
  • Phosphodiesterase 4 Inhibitors / therapeutic use*
  • Psoriasis / drug therapy*
  • Surveys and Questionnaires
  • Thalidomide / analogs & derivatives
  • Thalidomide / therapeutic use
  • Ustekinumab / therapeutic use


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Biological Products
  • Dermatologic Agents
  • Phosphodiesterase 4 Inhibitors
  • Thalidomide
  • Cyclosporine
  • Infliximab
  • secukinumab
  • Ustekinumab
  • Adalimumab
  • Etanercept
  • apremilast
  • Methotrexate