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Journal of the American Academy of Dermatology
Volume 80, n° 6
pages 1650-1657 (juin 2019)
Doi : 10.1016/j.jaad.2019.01.039
accepted : 21 January 2019
Original Articles

Patient-reported outcomes are important elements of psoriasis treatment decision making: A discrete choice experiment survey of dermatologists in the United States

Steven R. Feldman, MD, PhD a, Stephane A. Regnier, PhD b, , Alexandra Chirilov, BS c, Felix Hey, BA d, Isabelle Gilloteau, MSc b, David Cella, PhD e
a Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina 
b Novartis AG, Basel, Switzerland 
c GfK SE, Nuremberg, Germany 
d Ipsos SA, Nuremberg, Germany 
e Department of Medical Social Sciences, Northwestern University, Chicago, Illinois 

Correspondence: Stephane A. Regnier, PhD, Novartis Campus, CH-4056 Basel, Switzerland.Novartis CampusBaselCH-4056Switzerland

Psoriasis Area and Severity Index (PASI) response rates have been the benchmark for evaluating treatment efficacy in trials involving moderate-to-severe psoriasis.


To understand how dermatologists assess biologics and which trade-off rules they apply when planning psoriasis treatment.


Two online surveys of 130 and 129 US dermatologists (surveys 1 and 2, respectively) were conducted with use of direct and indirect elicitation via discrete choice experiment. Respondents were asked to choose hypothetical biologics on the basis of 6 attributes (a ≥75% reduction from baseline in PASI score or a ≥90% reduction from baseline in PASI score, infection risk, dosing frequency, and 3 patient-reported outcomes [PROs] [relief of depression, relief of itching, and impact on usual activities]).


Most dermatologists (74% in survey 1 and 76% in survey 2) reported using both PASI and PROs when selecting a biologic. PASI response rate was the most important attribute (35%-38% of overall decision weight), whereas combined PRO attributes had similar importance (36% of decision weight). Infection risk and dosing frequency influenced the decision to a lesser extent.


Potential bias in considering 3 PROs versus 1 PASI rate and 1 safety attribute.


PASI is most important for dermatologists selecting biologics, but PROs are also considered, especially when PASI response rate is similar between treatments. PRO data should be collected in trials involving moderate-to-severe psoriasis.

The full text of this article is available in PDF format.

Key words : biologics, patient-reported outcomes, psoriasis, Psoriasis Area and Severity Index, treatment decision making

Abbreviations used : HRQoL, PASI, PASI 75, PASI 90, PRO, SoP

 Funding sources: Supported by Novartis AG.
 Disclosure: Dr Feldman has received research, speaking, and/or consulting support from Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, AbbVie, Samsung, Janssen, Eli Lilly and Company, Merck, Novartis, and Sun Pharma. Dr Regnier and Ms. Gilloteau are employees of and own stock in Novartis AG. Ms Chirilov and Mr Hey are employees of GfK SE and Ipsos SA, respectively, which received funding for this study from Novartis. Dr Cella has received consulting honoraria from Novartis and research grants to his institution from Novartis.
 Reprints not available from the authors.

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