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Treatment Preferences Among Systemic Therapy-Naïve Patients with Atopic Dermatitis or Psoriasis in Germany: A Multicentre Study

Year: 2025

Type: article

Abstract: Despite the expanding range of approved systemic therapies for atopic dermatitis (AD) and psoriasis (PSO), data on patient preferences remain limited. It is largely unknown whether patients wish to initiate systemic treatment, which route of administration (oral versus subcutaneous) they prefer, or what factors drive their treatment preferences. This study evaluated the desire for systemic therapy among systemic treatment-naïve patients with AD or PSO, including disease-specific influencing factors and preferences for administration routes (subcutaneous injections vs. tablets). Eligible patients with AD or PSO were recruited at two German university hospitals. Questionnaires collected demographic and clinical data, including disease severity, pruritus and pain intensity, quality of life (QoL) impairment, and desire for systemic therapy. Data analysis comprised Mann–Whitney U tests (between-group comparisons), and Spearman correlations (factors influencing therapy desire). From 253 recruited patients, systemic treatment-naïve patients with moderate-to-severe disease severity exclusively using topical therapies were selected (56 with AD, 63 with PSO); 77.8% of patients with PSO and 67.9% of patients with AD desired systemic therapy, mainly for superior efficacy, QoL improvement, and pruritus reduction. Administration preferences differed significantly (PSO 57.1% injections; AD 73.7% tablets; p < 0.005). The desire for systemic therapy moderately correlated with pain intensity (ρ = 0.422, p < 0.001) and QoL impairment (ρ = 0.379, p < 0.005) in AD and with male sex in PSO (ρ = 0.347, p < 0.005). Most topically treated patients with moderate-to-severe AD or PSO desire systemic therapy, with distinct disease-specific administration preferences. Atopic dermatitis and psoriasis are long‑lasting inflammatory skin diseases that can strongly affect daily life. Both cause itching, pain, and visible skin changes, which may lead to emotional distress and social burden. In this prospective cohort study, we wanted to find out whether patients with atopic dermatitis or psoriasis who have never received systemic treatments wish to start one, and which form they would prefer (oral tablets or injections). We also explored what factors influence these preferences. This study was conducted at two university hospitals in Germany. A total of 253 adults completed questionnaires on symptoms, disease severity, quality of life, and preferred treatments. Only patients treated with creams or ointments were included in the evaluation (56 with atopic dermatitis, 63 with psoriasis). Most patients with moderate‑to‑severe atopic dermatitis (68%) or psoriasis (78%) expressed a desire for systemic therapy. The main reasons were better treatment results, improved quality of life, and less itching. Preferences for treatment type differed: patients with atopic dermatitis mainly preferred tablets, while those with psoriasis favoured injections. The wish for systemic therapy was linked to stronger pain and poorer quality of life in atopic dermatitis, and to male sex in psoriasis. Our study showed that patients’ preferences are shaped more by how much their condition affects their daily life than by objective disease severity. Discussing these preferences, such as route of administration and quality‑of‑life goals, can help dermatologists involve patients in shared decision‑making and improve satisfaction and adherence.

Source: Dermatology and Therapy

DOI: 10.1007/s13555-025-01615-8