Page 75 - JCTR-11-4

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

Adherence to topical treatments is generally poor, with treatment effectiveness to improve adherence. As
real-world application rates between 50% and 60% of demonstrated in this study, adherence issues are well-
prescribed doses, and patients applying only 35 – 72% of recognized contributors to therapeutic failure, preventing
the recommended dose. Key barriers to adherence include patients from achieving optimal clinical outcomes and
perceived low efficacy, time-consuming application, and significantly affecting their quality of life. 13-15
unfavorable cosmetic properties. These findings highlight Beyond clinical consequences, poor adherence also
the need for improved patient education and tailored imposes a substantial economic burden. Inadequate
strategies to enhance adherence. 24 disease control leads to increased direct and indirect
A systematic review and meta-analysis of 62 studies costs, including more frequent follow-up visits, higher
involving 169,371 psoriasis patients found an overall absenteeism from work or school, and the eventual need
adherence rate of 61% for biological therapies. Factors for costlier therapeutic alternatives. Thus, improving
25
influencing adherence included insurance coverage, patient adherence is directly linked to better psoriasis management
satisfaction, treatment efficacy, socioeconomic status, and reduced healthcare expenditures. 28
dosing frequency, and physician-patient relationship. Non-adherence to treatment can result from
Non-adherence can lead to increased healthcare costs, factors related to the patient, the patient-physician
as patients with treatment failures incur higher overall relationship, and the treatment itself. Patient-related
29
medical expenses. 26
risk factors include being male sex, single marital status,
30
Adherence to methotrexate—a widely available, unemployment, and excessive alcohol and tobacco use.
low-cost treatment in underdeveloped countries —was A poor physician-patient relationship is also a critical
lower than that of biological drugs. A study comparing determinant; loss of trust during consultations and
27
adherence rates among new users of biologics found lack of patient involvement in therapeutic decision-
significantly higher adherence to adalimumab (odds ratio making negatively impact adherence. Treatment-related
31
[OR] = 2.24), etanercept (OR = 1.77), and ustekinumab barriers to adherence are multifactorial, encompassing
(OR = 2.54) had greater adherence rates compared to intolerance or dissatisfaction with therapy, discomfort
methotrexate; Acitretin (OR = 0.57) had the lowest with pharmaceutical formulations, the time-consuming
adherence. 28 application of topical medications, fear of adverse effects,
The disparity in adherence between topical treatments and unmet patient expectations. 31-33
and biological agents highlights important factors The adverse effects of pharmacological treatments for
influencing patient behavior and decision-making. Topical psoriasis vary by drug class. Systemic immunosuppressants
therapies often fall short of full adherence because patients like methotrexate and cyclosporine carry risks of
struggle with their perceived inefficacy, the time and effort hepatotoxicity, nephrotoxicity, and increased susceptibility
required for application, and the cosmetic drawbacks of to infections. Biologic therapies, including TNF-α
some treatments. In contrast, biological treatments tend inhibitors (e.g., etanercept, adalimumab) and IL-17
to see better adherence, likely due to their convenience inhibitors, have been associated with serious infections,
and more noticeable results. However, even biologics injection site-related reactions, and exacerbation of
are not exempt from adherence challenges. This suggests preexisting conditions such as congestive heart failure
that factors like medication cost, accessibility, and patient or demyelinating diseases. Newer agents, such as
understanding of their condition and treatment continue phosphodiesterase-4 inhibitors (e.g., apremilast), are
to play a significant role. Addressing these issues is essential known to cause gastrointestinal disturbances, headaches,
for developing targeted interventions that improve and weight loss. Improving adherence in psoriasis
34
adherence across all treatment modalities. patients can be achieved through simple health education
interventions, which can significantly enhance clinical
In this study, a significant portion of participants
never experienced asymptomatic periods, highlighting outcomes, improve patient quality of life, and reduce
14
the challenge of achieving ideal treatment outcomes healthcare costs.
in practice. Failures in adherence and persistence were Beyond patient education, ensuring treatment
identified as key contributors to disease severity. The adherence requires a multidisciplinary approach,
primary reasons for treatment discontinuation included including collaborative patient care, cessation of alcohol
therapy-related discomfort, dissatisfaction with the lack and tobacco use, psychotherapy, and strengthening the
of visible improvement, and skepticism about treatment physician-patient relationship. Effective communication,
efficacy. These factors emphasize the need to enhance shared decision-making, and aligning treatment choices
patient comfort, manage expectations, and reinforce with patient expectations are essential for improving

Volume 11 Issue 4 (2025) 69 doi: 10.36922/jctr.24.00057