High Systemic Disease Risk and Therapeutic Delays in Plaque Psoriasis: A Retrospective Analysis of Apremilast Use in the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR).

Introduction: We describe comorbidities and cardiovascular diseases (CVD) risk in patients with psoriasis prescribed apremilast in UK clinical practice. Such real-world data are currently sparse.

Methods: This observational, retrospective analysis of British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) included adults with plaque psoriasis first prescribed apremilast between October 2015 and March 2021. We evaluated patient comorbidities, 10-year CVD risk (Framingham risk score), time from psoriasis diagnosis, prior therapy, psoriasis severity and patient-reported quality of life (QoL) at first apremilast prescription or registry enrolment. Patient characteristics were also assessed by CVD risk and Fitzpatrick skin type.

Results: Of 265 eligible patients, 47.5% were female; median (Q1, Q3) age at first apremilast prescription was 50 (38, 60) years. The most common comorbidities were hypertension (23.4%), depression (21.5%), psoriatic arthritis (18.1%) and diabetes (15.8%). Median (Q1, Q3) time from psoriasis diagnosis to first apremilast prescription was 19 (11, 30) years; median (Q1, Q3) number of prior psoriasis therapies was 1 (1, 2). Most patients had a Physician Global Assessment score ≥ 3 (moderate/moderate-to-severe/severe disease; 75.5%), psoriasis area severity index ≥ 10 (severe/extensive disease; 82.6%), nail or scalp involvement (52.8% and 75.5%, respectively), and reported moderate or extreme pain/discomfort (57.4%) and/or a Dermatology Life Quality Index (DLQI) > 10 (large/extremely large effect; 59.2%). Among 186 patients without CVD, 63.4% had an intermediate/high 10-year risk of CVD. Patients with darker skin (Fitzpatrick skin types IV-VI) reported worse QoL than those with lighter skin (Fitzpatrick skin types IV-VI, mean [SD] DLQI, 15.7 [7.9]; I-III, 13.9 [7.8]).

Conclusions: Our data indicate that patients with plaque psoriasis prescribed apremilast in UK clinical practice have a high comorbidity burden and long-term, moderate-to-severe disease with special-site involvement, uncontrolled by systemic therapy, and which had a large detrimental impact on their QoL. These data highlight the need for timely treatment with appropriate therapy following diagnosis.