Background/Purpose: Data suggest that patient satisfaction with drug therapy in psoriasis (Pso) and psoriatic arthritis (PsA) is associated with treatment compliance and, ultimately, disease response. Biologics, including IL-23 inhibitors such as risankizumab and guselkumab, have shown efficacy for both plaque psoriasis and psoriatic arthritis. However, meta-analyses reporting patient adherence to prescribed biologic therapy range from 61% to 70%, with limited data elucidating patients’ reasons for non-adherence. The objective of this study was to characterize patient-reported factors associated with adherence and efficacy among IL-23 inhibitors for psoriasis and psoriatic arthritis.

Methods: Data were collected from 37 consecutive adult patients with Pso and PsA treated with an IL-23 inhibitor (either risankizumab or guselkumab) from a single clinic at our institution from 2019 onwards. Patient-reported therapy satisfaction was assessed using an adapted Treatment Satisfaction Questionnaire for Medication (TSQM-9). The TSQM-9 is a validated instrument used to assess patient satisfaction with medication across three domains: effectiveness, convenience, and global satisfaction. TSQM-9 domain scores are calculated as recommended by the instrument authors and range from 0 to 100, with higher scores indicating increased satisfaction in that domain. Medication non-adherence was defined as at least one missed injection over the study period. Exploratory factor loading was conducted to identify specific attributes of therapy associated with adherence. Statistical analysis was performed using logistic regression.

Results: Our cohort consisted of 37 patients with a mean age of 49.7 ± 15.9 (standard deviation) years, of whom 54.1% were male. The mean treatment duration from drug initiation to the study period was 14.1 months ± 10.0, with 22 patients prescribed risankizumab and 15 patients prescribed guselkumab. In our cohort, 32% of patients reported at least one missed dose, and 5% of patients reported multiple missed doses. The overall TSQM-9 scores by domain were as follows: effectiveness 93.4 ± 7.9, convenience 93.4 ± 9.1, and global satisfaction 89.6 ± 15.9. Mean scores for TSQM-9 statistically differed (p < 0.05) between fully compliant patients and non-compliant patients for convenience (96.5 ± 5.4 vs. 87.6 ± 11.8). There were no intra-drug differences in satisfaction or adherence within our cohort despite variations in dosing regimens. Factor loading revealed medication planning, medication administration, and side effects as the top three variables responsible for satisfaction variance between groups.

Conclusion: This study suggests that differences in biologic therapy adherence among patients with psoriasis and psoriatic arthritis may be influenced by patient therapy convenience and satisfaction as defined by medication planning, administration, and side effects. Larger studies should further attempt to characterize and address specific barriers identified.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-patient-reported-drug-efficacy-and-adherence-among-il-23-inhibitors-for-psoriasis-and-psoriatic-arthritis/