Real-World Patient and Disease Characteristics, Treatment Outcomes and Satisfaction in Psoriasis: A Cross-Sectional and Retrospective Comparison of Advanced Therapies and Severities

INTRODUCTION: Psoriasis (PsO) is a chronic inflammatory skin disorder with variable severity. Traditional trial criteria based on Psoriasis Area and Severity Index (PASI) and body surface area (BSA) may not adequately reflect disease burden, particularly in patients with high-impact site involvement (scalp, groin/genitals, hands/feet, armpits). This study aimed to describe treatment outcomes, clinical characteristics, and satisfaction among patients receiving biologics or advanced oral therapies in real-world practice. METHODS: This cross-sectional analysis used data from the 2024 Psoriasis Wave XI of the Adelphi Real World Disease Specific Programme™ in the USA. Dermatologists completed patient record forms, and patients completed linked patient self-completion questionnaires. Patients were stratified by current treatment (biologics/biosimilars vs. advanced oral therapies) and physician-assessed disease severity (mild vs. moderate-to-severe). Descriptive and bivariate analyses were conducted. RESULTS: Among 682 patients, 466 (68.3%) had mild PsO and 216 (31.7%) had moderate-to-severe PsO. Of 517 receiving advanced systemic therapies, 134 (25.9%) received advanced oral therapies and 383 (74.1%) biologics. Prior to treatment initiation, mean BSA was similar between treatment groups (13.4% vs. 14.7%; p = 0.408), whereas PASI was lower in the advanced oral therapies group (6.2 vs. 9.3; p < 0.001). At consultation, BSA and PASI remained higher in the moderate-to-severe versus mild group (BSA 10.7% vs. 3.0%; PASI 7.9 vs. 2.0; both p < 0.001). Physician-reported satisfaction was lower for advanced oral therapies than biologics (50.0% vs. 75.0%), with moderate physician-patient agreement in both groups (kappa = 0.434 and 0.593, respectively). CONCLUSION: In this real-world study, mean PASI scores before treatment initiation were below typical clinical trial thresholds, highlighting a disconnect between trial eligibility criteria and clinical practice. Low physician-reported satisfaction with advanced oral therapies suggests ongoing unmet need for some patients receiving advanced oral therapy. These findings support broader, more patient-centered eligibility criteria that better reflect real-world PsO burden and treatment needs.