Therapeutic inertia in the management of patients with moderate to severe psoriasis: A systematic review of cross-sectional studies

Abstract

Therapeutic inertia (TI) is defined as the inability of physicians to intensify or initiate a more aggressive treatment in patients who need it. This study aims to explore the evidence behind TI in the management of patients with moderate to severe psoriasis and to determine the factors that contribute to its occurrence. An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN Plus from their inception up to June 2023. Cross-sectional studies that looked into TI in patients with moderate to severe psoriasis and discussed the factors that lead to its occurrence were included in the study. The review was limited to peer-reviewed journals in the English language. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted. Three thousand two hundred and fifty six records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4% to 35.6%. Its occurence is largely caused by physician-related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient-related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system-related factors were not directly explored. The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.