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Psoriasis, Biologics, DLQI, Geographic Variation, Patient Registry
Background: Patients with psoriasis frequently experience anxiety, depression, and increased psychological distress in association with their disease. Previous work has shown that Dermatology Life Quality Index (DLQI) scores directly associate with measures of disease severity and parallel treatment response.
Methods: Participants included new biologic initiations in 2018 in the CorEvitas Psoriasis registry with baseline and 6-month follow-up visits available. Logistic regressions resulted in adjusted odd ratios (OR) and 95% CIs for achievement of DLQI 0/1 for 7 US geographic regions.
Results: There were 737 new biologic initiations included in the study. Of these, 644 had DLQI > 0 at baseline. Baseline mean DLQI scores did not vary significantly among geographic regions. Overall, 42.7% of patients achieved DLQI 0/1 at 6-months. The Pacific region reported the smallest proportion achieving this target (26.9%) followed by the East South Central (ESC) (34.3%) and West South Central (WSC) (40.9%) with a range of 26.9-51.1% across all regions. In logistic regression models adjusted for age, sex, race, and BMI, the Pacific had 61% lower odds of achieving DLQI 0/1 compared to the Northeast.
Conclusions: Improvement of DLQI scores at 6-months of treatment for psoriasis is not geographically uniform across the United States. Regions that had the lowest proportions of achieving PASI75 also had the lowest proportions of patients achieving DLQI 0/1; yet when fully adjusted only patients in the Pacific were less likely to achieve DLQI 0/1, suggesting factors beyond treatment response impact patient quality of life.
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