The Pharmaceutical Journal
Vol 272 No 7296 p499
24 April 2004

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Less compliance with oral psoriasis therapy

Adherence to psoriasis treatment is greater with topical or combined therapy than with oral treatment. This is the finding of a compliance trial carried out by doctors at Leeds General Infirmary.

Some 200 patients completed the open, prospective study in which pill count and weight of topical therapy were used to measure adherence. The overall adherence rate was 60 per cent, although in interview, patients judged their adherence to be 92 per cent.

Being female, married, employed and not paying for prescriptions were characteristics associated with increased medication adherence and better quality of life. The major reasons for missing treatment were found to be drinking alcohol, being fed up, forgetfulness and being too busy. Patients with facial disease and more extensive psoriasis had lower adherence to medication.

Adherence rates were 72 per cent for topical therapy, 74 per cent for combined therapy and 46 per cent for oral therapy. The authors were surprised by this finding, thinking that oral treatment was less time consuming and easier to administer. However, dermatology pharmacist Samuel Bundu Kamara, St John’s Institute of Dermatology, London, told The Journal that it is patients with more severe disease who are likely to be put on oral therapy and that these treatments are often linked with side effects.

Adherence rates for once-daily medication were 82 per cent compared with 44 per cent for a twice-daily group. In those reporting adverse events, adherence was 46 per cent compared with 73 per cent for the group who did not. Adherence was 86 per cent for non-smokers compared with 45 per cent for smokers. Adherence also decreased with the increasing number of finger-tip units of topical therapy prescribed (Archives of Dermatology 2004;140:408).

Mr Bundu Kamara added that, in certain cases, patients with severe disease would be well motivated to reduce the severity of their symptoms. However, he acknowledged that factors such as depression could reduce motivation to comply with therapy. Disease severity was not measured in the study.