Page 71 - JCTR-11-4

Journal of Clinical and
Translational Research Adherence and psoriasis severity in Brazil

Psoriasis onset is primarily triggered by a combination findings from other countries while also identifying key
of genetic predisposition and environmental and behavioral differences in treatment compliance patterns. The overall
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factors, including obesity, smoking, excessive alcohol adherence in Italy (48.7%) aligns with global reports,
consumption, trauma, certain medications, and infections. In where failure to follow treatment recommendations
5
the last few decades, studies on the pathogenesis of the disease may reach 30 – 40%, especially for high-cost and
have highlighted the great importance of cytokines, such as complex therapeutic regimens, such as those in North
tumor necrosis factor-(TNF)-α, interleukin (IL)-17 and America. This comparison underscores the importance
IL-23, in sustaining the inflammatory process. Furthermore, of understanding local healthcare contexts and patient
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oxidative stress is linked to the severity of psoriasis, with demographics when addressing adherence challenges.
elevated markers such as malondialdehyde and nitric oxide The significance of this study lies in its comprehensive
observed in patients, alongside reduced antioxidant capacity analysis of the factors affecting adherence, which not only
and lower levels of vitamins A and E. Additionally, genetic provides crucial information for healthcare professionals
polymorphisms in glutathione S-transferase genes are in Italy but also offers a model adaptable to other countries
associated with susceptibility to psoriasis, potentially affecting facing similar obstacles in managing chronic diseases like
antioxidant defenses and inflammatory responses. After psoriasis. Identifying barriers to adherence and evaluating
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diagnosis, it is essential to determine the most appropriate the impact of treatment modifications are essential steps
therapy to improve clinical outcomes. toward developing targeted interventions that improve
patient outcomes on a global scale. 16,17 Therefore, it is
The ideal therapeutic goal for psoriasis patients is
complete lesion clearance, indicated by a 100% response of great relevance to assess adherence and persistence
on the Psoriasis Area Severity Index (PASI). However, a to psoriasis treatment in patients from southern Brazil
75% improvement (PASI75) from baseline is considered (Paraná state). Data from different populations provide
clinically significant. This benchmark does not fully critical insights into how environmental, socioeconomic,
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account for the detrimental effects of psoriasis on patients’ and cultural factors influence disease severity. Collecting
physical, psychosocial, and emotional well-being, which such localized information can improve patient outcomes
reduces their quality of life. Therefore, treatment objectives and healthcare efficiency in the region.
should also focus on improving patients’ overall well- The state of Paraná serves as the starting point for the
being. Achieving this requires physicians to understand Pso.BRA study, a pharmacoepidemiological investigation
both the full impact of the disease and the outcomes that of psoriasis aimed at identifying key patient, disease, and
matter most to the patients. To achieve therapeutic goals treatment characteristics across Brazil. Preliminary results,
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and improve the quality of life, treatment selection must be including the prevalence of comorbidities among patients
individualized, taking patient-specific factors into account, in Curitiba—an important factor in the clinical course of
and ensuring adequate adherence and persistence. the disease—have been previously published. Limited
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Adherence refers to the extent to which a patient information exists on adherence patterns within the
follows the prescribed dosing regimen in terms of timing Brazilian healthcare system, which faces unique challenges,
and dosage, while persistence refers to the duration from including socioeconomic disparities and varying levels of
treatment initiation to discontinuation—essentially, how access to specialized treatments such as biologics. Studies
long adherence is maintained. Therefore, any interruption analyzing the association between treatment adherence
in treatment is considered a failure in persistence. 10 and disease severity through a multicenter approach
can provide real-world insights into an understudied
Low treatment adherence among psoriasis patients has population and contribute important data to the global
been identified as a significant contributor to therapeutic understanding of psoriasis management. By addressing
failure and the inability to achieve treatment goals. The this research gap, this study—part of the Pso.BRA
main reasons for poor adherence include frustration with project—aims to evaluate correlations between psoriasis
treatment outcomes, perceived low efficacy, communication severity and treatment-related factors, such as adherence
gaps between physician and patient, and fear of treatment- and history of treatment interruption or discontinuation,
related adverse effects. 11,12 These adherence issues lead in patients from the state of Paraná.
to unsuccessful clinical management, negatively impact
overall health, and decrease quality of life. Additionally, 2. Materials and methods
they contribute to increased healthcare costs, as psoriasis A cross-sectional study was conducted using data from
therapy can be expensive. 13-15 voluntary patients of both sexes who consented to the
An Italian study on medication adherence among study by signing the informed consent form (ICF).
psoriasis patients provides valuable insights consistent with The study period spanned from January 28, 2022, to

Volume 11 Issue 4 (2025) 65 doi: 10.36922/jctr.24.00057