Lower Socioeconomic Status is Associated With Decreased Therapeutic Response to the Biologic Agents in Psoriasis Patients
February 2016 | Volume 15 | Issue 2 | Original Article | 147 | Copyright © February 2016
Eric P. Sorensen BS,ab Haitham Algzlan MD,a Shiu-chung Au MD,a Caren Garber BA,ac Kristina Fanucci BS,ac Michelle Bichchau Nguyen MD MPH,ac and Alice B. Gottlieb MD PhDac
aDepartment of Dermatology, Tufts Medical Center, Boston, MA
bUniversity of California, San Diego, School of Medicine, San Diego, CA
cTufts University School of Medicine, Boston, MA
OBJECTIVE: To examine the impact of individual socioeconomic status on systemic therapeutic outcomes amongst psoriasis patients.
METHODS: The study analyzed 156 psoriasis patients treated at the Tufts Medical Center Department of Dermatology from 2008-2014. Individual socioeconomic status was inferred from neighborhood income, defined as the percentage of households with income below the federal poverty line (% below FPL) in the patient’s census tract. The following outcomes were compared between socioeconomic groups: improvement in simple measure for assessing psoriasis activity (S-MAPA) score at 12 weeks, primary and secondary drug failure rates, and incidence of documented medication non-adherence.
RESULTS: Those patients living in relatively poorer neighborhoods (% below FPL ≤10%) experienced a significantly decreased improvement in S-MAPA score at 12 weeks of biologic treatment when compared to those in relatively richer neighborhoods (% below FPL >10%), 23.2% vs. 45.5%, P=0.021. Patients living in poorer neighborhoods also had a significantly higher rate of primary drug failure when treated with biologics (34.7% vs. 18.4%, P=0.039) and were significantly more likely to have ≥1 documented instance of medication non-adherence when treated with biologics (45.5% vs. 8.8%, P<0.001).
LIMITATIONS: Retrospective design, small sample size
CONCLUSIONS: Our study offers preliminary data that suggests lower socioeconomic status may be associated with decreased clinical response to the biologic agents, presumably through decreased medication adherence.
J Drugs Dermatol. 2016;15(2):147-153.