Topical Cycling and Systemic Eligibility in Patients With Psoriasis in Japan

Topical therapy is the typical first-line treatment for psoriasis, with the International Psoriasis Council recommending systemic therapy for patients with body surface area > 10%, high-impact site involvement, or topical therapy failure. A recent Japanese Delphi Consensus Study proposed a definition for topical failure that considers time on therapy, failure to respond, flare on therapy, and other concepts. Using 2 real-world data sources, this study aimed to describe topical cycling and evaluate systemic therapy eligibility among patients with psoriasis in Japan. With DeSC insurance claims data (January 1, 2017, to August 31, 2024), we evaluated topical therapy treatment patterns before systemic treatment initiation. With data from the Japanese subgroup of the UPLIFT survey, we applied recommendations from the Japan Delphi Study to estimate the proportion of patients receiving topical therapy who may be eligible for systemic treatment. Of 6361 patients with psoriasis from the DeSC database, at least 1 dispensing of a topical therapy (index event) and no systemic treatment at index, 9.5% initiated systemic therapy during follow-up (mean time to initiation 712.5 days). Most patients began with strong/very strong corticosteroids (35.0%) or combinations of topical therapies (± vitamin D; 41.8%), with a shift toward predominantly combination regimens during follow-up. Most patients received multiple topical therapy classes before initiating systemic therapy (mean unique classes: 3.8). Of 137 Japanese UPLIFT survey respondents with psoriasis with or without psoriatic arthritis using only topical therapy, 92.7% met at least 1 of the 7 Delphi consensus recommendations assessed, indicating potential eligibility for systemic treatment; 87.6% met more than 1 recommendation and 57.7% met 3 or more. Our findings suggest that many Japanese adults with psoriasis who may be eligible for systemic therapy may be undertreated and highlight the need to apply eligibility criteria for systemic treatment in clinical practice, which could improve long-term patient outcomes.