Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
J Am Acad Dermatol. 2012 Mar;66(3):376-86. doi: 10.1016/j.jaad.2011.03.012. Epub 2011 Aug 19.
Despite increasing therapies for moderate to severe psoriasis, dermatologists' treatment preferences are unknown.
We sought to assess dermatologists' preferences for first-line treatments and their selection determinants.
We surveyed 1000 US dermatologists (500 National Psoriasis Foundation and 500 American Academy of Dermatology members who treat psoriasis) about their preferences for first-line treatment of moderate to severe psoriasis in healthy adults of childbearing age using standardized patient vignettes.
The response rate was 39% (N = 387). Preferred therapies for male and female patients were: ultraviolet (UV) B (40% and 56%, respectively), etanercept (15% and 19%), methotrexate (16% and 4%), and adalimumab (12% and 10%). Of respondents, 66% administered phototherapy in their practice. After adjusting for all physician characteristics, those preferring first-line UVB for male or female patients were significantly more likely to have phototherapy in their practice (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.8-6.6 and OR 2.8, 95% CI 1.5-5.3, respectively) and to have used UVB in more than 10 patients in the last 3 months (OR 8.0, 95% CI 3.9-16.4; OR 9.6, 95% CI 4.3-21.6). Dermatologists in the Midwest were more likely than those in the Northeast to prefer adalimumab first line for male and female patients.
We surveyed only dermatologists with interest in treating psoriasis and elicited their treatment preferences for a single base case scenario. Treatment preferences may differ between survey respondents and nonrespondents.
UVB is most commonly preferred as a first-line treatment for moderate to severe psoriasis in healthy adults, and preferences vary based on region, phototherapy availability, and prior treatment use.
尽管针对中重度银屑病的治疗方法不断增加，但皮肤科医生的治疗偏好尚不清楚。
我们旨在评估皮肤科医生对一线治疗方法的偏好及其选择的决定因素。
我们使用标准化患者病历对 1000 名美国皮肤科医生（500 名全国银屑病基金会成员和 500 名美国皮肤病学会成员，他们治疗银屑病）进行了调查，了解他们对生育年龄的健康成年人中重度银屑病的一线治疗方法的偏好。
回复率为 39%（N=387）。男性和女性患者的首选治疗方法分别为：紫外线（UV）B（分别为 40%和 56%）、依那西普（分别为 15%和 19%）、甲氨蝶呤（分别为 16%和 4%）和阿达木单抗（分别为 12%和 10%）。在回答者中，有 66%的人在实践中使用光疗。在调整了所有医生特征后，那些对男性或女性患者首选一线 UVB 的医生更有可能在实践中使用光疗（优势比[OR]3.4，95%置信区间[CI]1.8-6.6 和 OR 2.8，95% CI 1.5-5.3），并且在过去 3 个月中对超过 10 名患者使用了 UVB（OR 8.0，95% CI 3.9-16.4；OR 9.6，95% CI 4.3-21.6）。与东北部的医生相比，中西部的医生更倾向于将阿达木单抗作为男性和女性患者的一线治疗药物。
我们只调查了对治疗银屑病感兴趣的皮肤科医生，并引出了他们对单一基础案例的治疗偏好。治疗偏好可能因调查对象和非调查对象而异。
在健康成年人中，UVB 是治疗中重度银屑病最常用的一线治疗方法，其偏好因地域、光疗的可获得性以及先前的治疗使用而有所不同。
