Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

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ac

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at

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83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

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ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
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R
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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

100

150

200

250

300

350

400

P
at

ie
n
ts

 w
h
o
 c

o
m

p
le

te
d
 s

u
rv

e
y,

 n

Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

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ac

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c 
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an
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at

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ts

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%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

0

10

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30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

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20

30

40

50

60

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ce

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ou

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n

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os

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g

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os

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D
os

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fr
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q
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cy

D
u
ra

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of

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sp

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m

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it

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R
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D
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fr
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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

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250

300

350

400

P
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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

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53.7%

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A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

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P
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, 
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60

70

80

90

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P
at

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, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

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30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
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 c
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ce

R
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n

Sa
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D
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D
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Sk
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R
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Sa
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D
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D
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D
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Sa
fe

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D
os

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fr
e
q
u
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n
cy

D
u
ra

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of

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sp

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se

La
b
or

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m

on
it

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in

g

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ar
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ce

R
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m
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tr

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n

Sa
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ty

D
os

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g 

fr
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q
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cy

D
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m

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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

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150

200

250

300

350

400

P
at

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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

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90

100

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53.7%

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A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

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, 
%

0

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30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

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20

30

40

50

60

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La
b
or

at
or

y 
m

on
it

or
in

g

Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

Scientific Content on Demand
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Scan QR code via a barcode 
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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

100

150

200

250

300

350

400

P
at

ie
n
ts

 w
h
o
 c

o
m

p
le

te
d
 s

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rv

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 n

Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

Ap
re

m
ila

st
TN

Fi

Us
te

ki
nu

m
ab

To
pi
ca

l t
he

ra
py

W
hi
te

Bl
ac

k

Pr
ef

er
re

d 
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t

to
 a
ns

we
r

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he

r
No

ne Mi
ld

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de

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te

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ve

re

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C 

or
 n
o

tr
ea

tm
en

t

As
ia
n,

 A
m
er

ic
an

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di
an

/

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as

ka
 N

at
iv
e,

 N
at

iv
e 
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wa
iia

n/

ot
he

r P
ac

ifi
c 
Isl

an
de

r

P
at

ie
n
ts

, 
%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
in

 c
le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

is
tr

at
io

n

Sa
fe

ty

D
os

in
g 

fr
e
q
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cy

D
u
ra

b
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of

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sp

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se

La
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m

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or
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g

Sk
in

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ar
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ce

R
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 o

f 
ad

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in

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tr

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io

n

Sa
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ty

D
os

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g 

fr
e
q
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cy

D
u
ra

b
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of

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e
sp

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Sk
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ar
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ce

R
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 o

f 
ad

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in

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io

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D
os

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fr
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cy

D
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ra

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R
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 o

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D
os

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fr
e
q
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cy

D
u
ra

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of

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e
sp

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se

La
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m

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Sk
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ce

R
ou

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 o

f 
ad

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in

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tr

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io

n

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fe

ty

D
os

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g 

fr
e
q
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e
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cy

D
u
ra

b
il
it

y 
of

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e
sp

on
se

La
b
or

at
or

y 
m

on
it

or
in

g

Sk
in

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le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

is
tr

at
io

n

Sa
fe

ty

D
os

in
g 

fr
e
q
u
e
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cy

D
u
ra

b
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it

y 
of

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e
sp

on
se

La
b
or

at
or

y 
m

on
it

or
in

g

Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

Scientific Content on Demand
To request a copy of this poster:

Scan QR code via a barcode 
reader application

QR codes are valid for 30 days after the 
congress presentation date.



Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

Ap
re

m
ila

st
TN

Fi

Us
te

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 N

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ac

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c 
Isl

an
de

r

P
at

ie
n
ts

, 
%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

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n
ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
in

 c
le

ar
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ce

R
ou

te
 o

f 
ad

m
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io

n

Sa
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D
os

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fr
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q
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R
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os

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os

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D
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it

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R
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Sa
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D
os

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fr
e
q
u
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cy

D
u
ra

b
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of

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sp

on
se

La
b
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m

on
it

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in

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Sk
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R
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ad

m
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D
os

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fr
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q
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D
u
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m

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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

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300

350

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P
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u
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y,

 n

Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

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83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

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ts

, 
%

0

10

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30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

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40

50

60

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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

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90

100

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%

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83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

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, 
%

0

10

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30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

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40

50

60

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m

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in

g

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g 

fr
e
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cy

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g 

fr
e
q
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cy

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ra

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it

y 
of

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e
sp

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se

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or

at
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m

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it

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in

g

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le

ar
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ce

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in

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tr

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n

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fe

ty

D
os

in
g 

fr
e
q
u
e
n
cy

D
u
ra

b
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y 
of

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e
sp

on
se

La
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or

at
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y 
m

on
it

or
in

g

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in

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le

ar
an

ce

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 o

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ad

m
in

is
tr

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n

Sa
fe

ty

D
os

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g 

fr
e
q
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cy

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ra

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Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

100

150

200

250

300

350

400

P
at

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ts

 w
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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

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re

m
ila

st
TN

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te

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pi
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ac

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, 
%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
in

 c
le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

is
tr

at
io

n

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os

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fr
e
q
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cy

D
u
ra

b
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y 
of

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e
sp

on
se

La
b
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at
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m

on
it

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in

g

Sk
in

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le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

is
tr

at
io

n

Sa
fe

ty

D
os

in
g 

fr
e
q
u
e
n
cy

D
u
ra

b
il
it

y 
of

 r
e
sp

on
se

La
b
or

at
or

y 
m

on
it

or
in

g

Sk
in

 c
le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

is
tr

at
io

n

Sa
fe

ty

D
os

in
g 

fr
e
q
u
e
n
cy

D
u
ra

b
il
it

y 
of

 r
e
sp

on
se

La
b
or

at
or

y 
m

on
it

or
in

g

Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

Scientific Content on Demand
To request a copy of this poster:

Scan QR code via a barcode 
reader application

QR codes are valid for 30 days after the 
congress presentation date.



Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

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300

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Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

Ap
re

m
ila

st
TN

Fi

Us
te

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m
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he

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te

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t

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er

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 N

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at

iv
e 
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he

r P
ac

ifi
c 
Isl

an
de

r

P
at

ie
n
ts

, 
%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
in

 c
le

ar
an

ce

R
ou

te
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f 
ad

m
in

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io

n

Sa
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D
os

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fr
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cy

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os

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os

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it

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R
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D
os

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fr
e
q
u
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cy

D
u
ra

b
il
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of

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e
sp

on
se

La
b
or

at
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m

on
it

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ce

R
ou

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f 
ad

m
in

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tr

at
io

n

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fe

ty

D
os

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fr
e
q
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cy

D
u
ra

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m

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g

Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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Evaluating treatment choice among patients with moderate or severe psoriasis in the United States
April W. Armstrong,1 Sayeli Jayade,2 Sanika Rege,2 Namita Joshi,2 Vardhaman Patel,3 David Davidson,3 Samaneh Kalirai,3 Daniel Wolin,4 Kimberly Boyle,4 Dipen Patel,2 Lauren Seigel3
1Keck School of Medicine, University of Southern California, Los Angeles, CA; 2OPEN Health, Bethesda, MD; 3Bristol Myers Squibb, Princeton, NJ; 4RTI Health Solutions, Research Triangle Park, NC 

Presented at the 2022 Fall Clinical Dermatology Conference; October 20–23, 2022; Las Vegas, NV This poster may not be reproduced without written permission from the authors.Email for April W. Armstrong, MD, MPH: aprilarmstrong@post.harvard.edu

Synopsis
• While several psoriasis treatments are available and in development, different treatment modalities are associated with varying 

effectiveness, risks, and economic burden, and these factors are likely to influence patients’ decisions related to their psoriasis 
treatment1

• This study explored the element of treatment decision-making driven by patient experiences
 — A cross-sectional, web-based survey captured the demographic and clinical characteristics, treatment attributes affecting 

therapeutic decisions, and perceptions of a new, hypothetical, once-daily oral psoriasis treatment (deucravacitinib) among 
patients with moderate to severe plaque psoriasis

• Understanding the factors that drive patients’ treatment preference is crucial for guiding clinical decision-making

Objectives
Primary
• To identify factors associated with the choice of a new once-daily oral psoriasis treatment with efficacy superior to that of 

existing oral therapies in patients with moderate to severe psoriasis currently receiving apremilast, tumor necrosis factor 
inhibitors (TNFis), ustekinumab, topicals, or nonprescription treatments

Secondary
• To rank the importance of treatment attributes to patients with moderate to severe psoriasis using apremilast, TNFis, 

ustekinumab, topicals, or nonprescription treatments

• To elicit views on a new once-daily oral psoriasis treatment among patients with moderate to severe psoriasis using apremilast, 
TNFis, ustekinumab, topicals, or nonprescription treatments

Target product profile (deucravacitinib)
• Tablet formulation with once-daily dosing

• Clinical studies showed:
 — 53% of patients reported clear/mostly clear skin within 4 months
 — 83% of patients who reported a 75% reduction in psoriasis severity maintained this improvement at 1 year
 — Non-serious adverse events, such as cold-like symptoms, headache, diarrhea, nausea, rash, and risk of herpes infection, led to 

few discontinuations

• Regular laboratory monitoring is not required, although pre-initiation testing may be needed

• Out-of-pocket costs may be similar to those of the alternative psoriasis treatments in consideration

Methods
• A cross-sectional, web-based survey of the demographics and clinical characteristics of patients with psoriasis, their views on 

treatment characteristics that affect treatment-related decisions, and their perceptions of a new, hypothetical, once-daily oral 
psoriasis treatment 

• Patients were assigned to predefined treatment groups: apremilast, a TNFi, ustekinumab, a topical therapy/phototherapy, and 
over-the-counter (OTC) treatments or no treatment, based on their self-reported current treatment at the time of 
the survey

• A hypothetical psoriasis treatment profile, described by dosage, efficacy, adverse effects, and out-of-pocket costs, was shown 
to the patients to elicit their views on: (1) interference with everyday life, (2) convenience, (3) treatment-related anxiety, and 
likelihood of initiating treatment, both (4) without a safety warning and (5) with a safety warning

Inclusion criteria
• ≥18 years of age  

• Residing in the United States 

• Able to read and understand English

• Physician-diagnosed (self-reported) moderate or severe plaque psoriasis 

Exclusion criteria
• Mild psoriasis

• Lack of online consent for the web-based survey 

Data collection process
• The study was reviewed and approved by an Institutional Review Board

• The study used a convenience sample of patients with moderate or severe psoriasis who were recruited by Global Perspectives to 
collect patient-reported data

• Patients were asked to complete an electronic patient survey that included questions from patient-reported outcome (PRO) 
instruments and de novo questions

• Potential survey participants were provided with a link to the survey and completed screening questions to determine eligibility, 
followed by an informed consent checkbox

• The final survey was administered to 882 patients

Statistical analysis
• Stepwise multivariable logistic regression was conducted to determine sociodemographic and clinical characteristics associated 

with the choice of the new treatment among patients who were currently receiving treatment or who had never received 
treatment

 — Independent variables: treatment group, age, sex, race/ethnicity, psoriasis severity over the past week, comorbidities, 
disease and treatment duration, presence of psoriatic arthritis (PsA) at baseline, number of flares, and number of body 
regions affected

• Treatment attributes (route of administration, extent of skin clearance, laboratory monitoring, durability, safety, and dosing 
frequency) were ranked as an ordinal category (scale of 1–6) by patients

• Chi-square test was conducted to detect significant differences between patient rankings of each treatment attribute and to 
assess the variations in patient views on the new oral treatment

Results
• Figure 1 shows the responses of the 5 baseline treatment groups surveyed

• The study sample included 882 patients (mean age = 45.7 [±12.8] years); the majority were female (67.7%), most were White 
(74.9%), and their average duration of time since psoriasis diagnosis was 14.9 (±11.8) years (Figures 2 and 3; Table 1)

• Of 882 patients, 818 (92.8%) were currently receiving treatment and had been on their current treatment for a mean of 2.9 
(±4.8) years (Table 2)

• With their current treatment regimen, 50.8% of patients in the total study population described their psoriasis over the past 
week as mild, very mild, or none, while 36.5% reported it as moderate and 12.7% reported it as severe or very severe (Table 2)

Figure 1. Targeted baseline treatment groups

344

242

98 98 100

0

50

100

150

200

250

300

350

400

P
at

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 w
h
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p
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d
 s

u
rv

e
y,

 n

Treatment group

Group 1:
Apremilast

Group 2:
TNFi

Group 3:
Ustekinumab

Group 4:
Topical/phototherapy

Group 5:
Exploratorya

aThe exploratory group included patients who were using nonprescription treatments (n = 36), patients who had never received treatment (n = 17), and patients who had received treatment in 
the past but were not currently receiving treatment (n = 47).
TNFi, tumor necrosis factor inhibitor. 

Figure 2. Key baseline characteristics, by sex (A) and race/ethnicitya (B)

74.9%

14.1%

2%

2%

0.2%
2.4%

6.1%
White

Black

American Indian/
Alaska Native 

Asian

Native Hawaiian/
other Pacific Islander

Other

Preferred not
to answer

B.A.

Male

Female

Preferred not
to answer

32.0%

67.7%

0.3%

aPercentages sum to >100% because respondents could select multiple races/ethnicities, as applicable.

Figure 3. Key baseline characteristics for all 
respondents by insurance typea

13.6%

11.9%

54.5%

21.1%

2.2%
3.4%

Medicare

Medicaid

Employer-sponsored
private insurance

Individually purchased
private insurance

Uninsured

Military/veterans'
coverage

aPercentages sum to >100% because respondents could select more than 1 insurance type, as applicable.

Table 1. Key baseline characteristics 
for all respondents by patient age

Category
All respondents 

(N = 882)

Mean 45.71

Median (Q1–Q3) 45

Range 18–76

Q1–Q3, quartiles 1–3.

Table 2. Key baseline clinical characteristics
Parameter Statistic or category All respondents, N = 882 (%)

Treatment status, n (%)

Currently receiving treatment 818 (92.8)

Was receiving treatment but has stopped 47 (5.3)

Never received treatment 17 (1.9)

Treatment duration, years

Mean (SD) 2.86 (4.81)

Median (Q1–Q3) 1.0 (0.0–3.0)

Range 0.0–42.0

Current treatment type, n (%)

Over-the-counter nonprescription 225 (27.5)

Topical prescription steroid 230 (28.1)

Topical vitamin D analog 49 (6.0)

Other topical treatment 55 (6.7)

Ultraviolet light/phototherapy 51 (6.2)

Apremilast 356 (43.5)

Ustekinumab 101 (12.3)

TNFi treatment 251 (30.7)

Psoriasis severity over the past week, n (%)

None 31 (14.8)

Very mild 155 (17.6)

Mild 162 (18.4)

Moderate 322 (36.5)

Severe 86 (9.8)

Very severe 26 (2.9)

BSA, body surface area; Q1–Q3, quartiles 1–3; SD, standard deviation; TNFi, tumor necrosis factor inhibitor.

• Among patients who were currently receiving treatment or who had never received treatment (n = 835), apremilast (41.2%) and 
TNFis (29.0%) were the most commonly used treatments, and OTC or no treatment was the least common group (6.3%) (Table 3)

• Of patients who had never received treatment, 88.2% expressed intent to start the new oral psoriasis treatment, compared with 
80.6% of patients who used nonprescription OTC treatment, 75.5% of patients who used ustekinumab, 74.0% of patients who used 
a TNFi, 69.4% of patients who used topical therapy, and 55.2% of patients who used apremilast (Figure 4)

• Willingness to start the new, once-daily oral treatment was high across all groups, including patients currently using apremilast

• In response to questions about the new treatment, 83.7% reported that it would be convenient, 65.0% reported that it would 
cause less anxiety than an injection or infusion, 55.3% reported that it would interfere less with their everyday life, and 50.2% 
reported that it would reduce their symptoms more than their current psoriasis treatment (Figure 5)

Table 3. Intent to start a new once-daily oral psoriasis treatment

Variable Category

Intent to start new treatment

All,
N = 835 (%)

Yes,
n = 555 (%)

No,
n = 280 (%)

Treatment group

Apremilast 344 (41.2) 190 (34.2) 154 (55.0)

TNFi 242 (29.0) 179 (32.3) 63 (22.5)

Ustekinumab 98 (11.7) 74 (13.3) 24 (8.6)

Topical therapy 98 (11.7) 68 (12.3) 30 (10.7)

OTC or no treatment 53 (6.3) 44 (7.9) 9 (3.2)

Race/ethnicity

White 610 (73.1) 390 (70.3) 220 (78.6)

Black 114 (13.7) 95 (17.1) 19 (6.8)

Asian, American Indian/Alaska Native, 
Native Hawaiian/other Pacifi c Islander

32 (3.8) 21 (3.8) 11 (3.9)

Preferred not to answer 54 (6.5) 29 (5.2) 25 (8.9)

Other 25 (3.0) 20 (3.6) 5 (1.8)

Psoriasis severity over the 
past week (based on 
a 6-point scale)

None 130 (15.6) 48 (8.6) 82 (29.3)

Mild 308 (36.9) 197 (35.5) 111 (39.6)

Moderate 298 (35.7) 228 (41.1) 70 (25.0)

Severe 99 (11.9) 82 (14.8) 17 (6.1)

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 4. Intent to start a new once-daily oral treatment, by treatment group (A), race/
ethnicity (B), and psoriasis severity over the past week (C), all P < 0.001

55.2%

74.0% 75.5% 69.4%
83.0%

0

10

20

30

40

50

60

70

80

90

100

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re

m
ila

st
TN

Fi

Us
te

ki
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m
ab

To
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ca

l t
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te

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ac

k

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we
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r
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or
 n
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t

As
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 A
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er

ic
an

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ka
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at
iv
e,

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at

iv
e 
Ha

wa
iia

n/

ot
he

r P
ac

ifi
c 
Isl

an
de

r

P
at

ie
n
ts

, 
%

63.9%

83.3%

65.6%
53.7%

80.0%

A. B.

36.9%

64.0%
76.5%

82.8%

C.

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

OTC, over the counter; TNFi, tumor necrosis factor inhibitor.

Figure 5. Views on a new once-daily oral treatment, by treatment group

0

10

20

30

40

50

60

70

80

90

100

P
at

ie
n
ts

, 
%

Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes Neither
yes nor

no

No Yes No

Less interference with
daily life (P < 0.001)

Convenience of treatment
(P = 0.094)

Less anxiety than with
injection/infusion

(P = 0.041)

Reduction in symptoms
compared with current
treatment (P < 0.001)

Intent to start
new oral psoriasis

treatment
(P < 0.001)

Apremilast (n = 344) TNFi (n = 242)
Ustekinumab (n = 98) Topical therapy/phototherapy (n = 98)

TNFi, tumor necrosis factor inhibitor.

• Only treatment group, race/ethnicity, and psoriasis severity were statistically significant factors in the model

• The following responses were examined for intent to start a new once-daily oral treatment (yes/no), by selected categories:

 — 83% of Black respondents would start the new once-daily oral treatment
• Compared with White patients, the odds ratio (OR) of intent to start the new treatment was 2.4 (95% confidence interval 

[CI], 1.4–4.2) among Black respondents (P = 0.036)

 — Intent to start the new once-daily oral treatment increased with psoriasis severity over the past week, with 76.5% of 
respondents with moderate psoriasis and 82.8% of respondents with severe disease answering “yes”

• Compared with patients with no psoriasis symptoms or signs over the past week, the OR of intent to start the new 
treatment was 3.2 (95% CI, 2.0–4.9) among patients with mild psoriasis, 5.0 (95% CI, 3.1–8.2) among patients with 
moderate psoriasis, and 7.6 (95% CI, 3.9–15.0) among patients with severe psoriasis; all P < 0.001

 — 79.6% of patients who responded that the new once-daily oral treatment would cause them less anxiety than an injection 
would start the new treatment

 — 87.6% of respondents who believed that the new once-daily oral treatment would reduce their symptoms more than their 
current treatment would start the new treatment

• Asked to rank characteristics of psoriasis treatment in order of importance, 58.3% of respondents ranked “extent of skin 
clearance” as first or second, while 43.7% ranked “route of administration” as first or second (Figure 6)

• Laboratory monitoring was ranked least important by more than half (53.0%) of the patients

Figure 6. Reason for treatment choice ranking

37.1

22.8

17.0

11.9
10.0

1.3

21.2 20.9

15.0

20.3
19.1

3.5

22.1

18.6

15.5

20.2
18.0

5.6

12.2

19.1

22.3
19.8

14.7
11.8

5.9

12.4

21.3
19.5

16.0

24.9

1.5

6.2
8.8 8.3

22.2

53.0

0

10

20

30

40

50

60

Sk
in

 c
le

ar
an

ce

R
ou

te
 o

f 
ad

m
in

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io

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os

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fr
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R
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os

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fr
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D
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m

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R
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os

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fr
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cy

D
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ra

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m

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it

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R
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f 
ad

m
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Sa
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D
os

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fr
e
q
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cy

D
u
ra

b
il
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of

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sp

on
se

La
b
or

at
or

y 
m

on
it

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in

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Sk
in

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ar
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R
ou

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ad

m
in

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tr

at
io

n

Sa
fe

ty

D
os

in
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fr
e
q
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cy

D
u
ra

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of

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m

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R
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m

on
it

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g

Rank 1 (P < 0.001) Rank 2 (P = 0.005) Rank 3 (P = 0.030) Rank 4 (P = 0.233) Rank 5 (P = 0.005) Rank 6 (P < 0.001)

P
at

ie
n
ts

, 
 %

Conclusions
• This large, real-world study provided an account of how psoriasis impacts patients’ lives and treatment choices

• Patients with severe disease, Black patients, and patients receiving injectable treatments were more likely to 
choose the new oral treatment compared with patients with mild disease, White patients, and patients receiving 
apremilast, respectively

• Willingness to start the new psoriasis treatment was common among all treatment groups

• The new treatment was viewed as causing less anxiety compared with injectables across all treatment groups

• Extent of skin clearance and route of administration were reported as the top-ranked reasons for patients' psoriasis 
treatment choice

• Consideration of the treatment characteristics that drive the decision-making of patients with psoriasis is crucial for 
making effective treatment recommendations in clinical practice

Reference
1. Feldman SR, et al. J Health Econ Outcomes Res. 2016;4:141-157.

Acknowledgments
• This study was sponsored by Bristol Myers Squibb

• Medical writing and editorial assistance was provided by Tulika Bhushan Bahukhandi, RPh, MS, of Peloton Advantage, LLC, an OPEN Health 
company, and funded by Bristol Myers Squibb

Disclosures
• AWA: Has served as a research investigator, scientific advisor, and/or speaker for AbbVie, Almirall, Arcutis Biotherapeutics, ASLAN, Beiersdorf, 

Boehringer Ingelheim/Parexel, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI, Incyte, Leo, Janssen, Nimbus, Novartis, Ortho 
Dermatologics, Pfizer, Sanofi Genzyme, Sun, Regeneron, and UCB

• LS, DD, SK, and VP: Employees of and may own stock options in Bristol Myers Squibb

• NJ, SR, SJ, and DP: Employees of OPEN Health, which received consulting fees from Bristol Myers Squibb

• DW and KB: Employees of RTI Health Solutions, which received consulting fees from Bristol Myers Squibb

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