Original article
Uncovering burden disparity: A comparative analysis of the impact of moderate-to-severe psoriasis and hidradenitis suppurativa

https://doi.org/10.1016/j.jaad.2017.07.027Get rights and content

Background

Psoriasis and hidradenitis suppurativa (HS) exhibit distinct clinical features, but no studies have directly compared the health-related quality of life (HRQoL) in patients with moderate-to-severe manifestations of these conditions.

Objective

To determine which disease is associated with more severe HRQoL impairment.

Methods

Weighted averages of each of the following baseline HRQoL measures were determined and compared between HS and psoriasis populations from 5 clinical trials: Visual Analog Scale (VAS) for pain, Total Work Productivity Impairment, Dermatology Life Quality Index; EuroQOL 5D VAS, and Short Form-36 Health Survey.

Results

Compared with patients with psoriasis, patients with HS reported higher scores for VAS-pain (54.3 vs 36.1 [P < .0001]), Dermatology Life Quality Index (15.3 vs 11.3 [P < .0001]), EuroQOL 5D VAS (58.8 vs 50.8 [P < .0002]), and Total Work Productivity Impairment (35.4 vs 18.2). Patients with HS had lower Short Form-36 Health Survey scores than did patients with psoriasis (physical, 39.6 vs 49.0; mental, 41.5 vs 47.5 [both P < .0001]).

Limitations

This analysis was performed using published summary data rather than patient-level data, and weighted pooled averages were compared.

Conclusions

Patients with HS have a higher HRQoL burden than patients with psoriasis. This study clearly documents the needs of patients with HS and the potential impact of medical, scientific, and societal consensus for the development of more effective HS treatments.

Section snippets

Study design

Five international clinical trials of adalimumab for HS and plaque psoriasis that included at least 1 US study site were selected. A comparative analysis of HRQoL measures among populations pooled from selected clinical trials was conducted using baseline values. This study was exempt from review by an institutional review board (IRB).

Description of included trials

For HS, 3 trials were included: PIONEER I (a phase III, multicenter study of the safety and efficacy of adalimumab in subjects with moderate-to-severe HS),

Study characteristics

Baseline demographic and disease characteristics were compared between respective HS and psoriasis studies (Table II). Patient demographics and duration and severity of disease were similar between individual psoriasis study populations. The severity distribution of HS populations differed; the PIONEER trials included a larger proportion of Hurley stage III patients with HS compared with the proportion of such patients in NCT00918255 because of different inclusion criteria (ie, patients with

Discussion

This study suggests that patients with moderate-to-severe HS experience greater pain, increased work impairment, and reduced HRQoL than do patients with moderate-to-severe plaque psoriasis. The analysis corroborates previous findings that HS imposes a higher HRQoL burden than other dermatologic conditions, including psoriasis.2, 32

Although the literature demonstrates that both HS and psoriasis are associated with chronic and debilitating pain, the magnitude of pain has not been previously

Conclusion

These results illustrate the greater burden on the HRQoL of patients with HS than on the HRQoL of patients with psoriasis according to the 5 HRQoL measures (VAS-pain, DLQI, EQ-5D VAS, SF-36 PCS, and SF-36 MCS). The greater impact on HRQoL in patients with HS may contribute to the higher cost of managing HS compared with that of managing psoriasis.28, 35 Untreated patients with HS present greater HRQoL impairments than do patients with psoriasis; thus, the relative change in HRQoL following

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    Design, study conduct, and financial support for the study were provided by AbbVie Inc, which participated in interpretation of the data and review and approval of the manuscript. All authors contributed to the development of the publication and maintained control over the final content.

    Disclosure: Dr Hamzavi has served or currently serves as an investigator in clinical trial activities for AbbVie Inc, Adelphi Values, and The Microdermis Corporation, with research grants paid to his institution, and he is also the current president of the Hidradenitis Suppurativa Foundation in a nonfunded position. Drs Arikian, Zivkovic, and Lee and Ms Yi have current consulting agreements with AbbVie Inc. Dr Okun is a consultant to United BioSource Corporation (UBC), serves on the speaker's bureau for AbbVie Inc, is a former AbbVie employee, and may have owned AbbVie Inc, stock or stock options. Drs Ganguli and Yihua Gu are employees of AbbVie Inc, and may own AbbVie Inc, stock or stock options. Dr Sundaram is a former employee of AbbVie Inc, and may have owned AbbVie Inc stock or stock options. Ms Parks-Miller serves or has served on an advisory board for AbbVie Inc, has a current consulting agreement with AbbVie Inc, receives funding as the national coordinator of advocacy and support for the Hidradenitis Suppurativa Foundation, and is the founding director of Hope for Hidradenitis Suppurativa. Dr Nicholson is a nonfunded committee member for the Hidradenitis Suppurativa Foundation.

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