Therapeutic Strategies and Decision-Making to Optimize Psoriasis Treatment: A French National Survey Based on Virtual Case Vignettes

Despite current treatments for psoriasis, effective disease control remains challenging for physicians. Current recommendations provide information on when treatment should be optimized, but providing guidance on how to optimize treatments in real-word practice is complex. To examine the decision-making practices of dermatologists when optimizing the management of mild or moderate-to-severe psoriasis, we conducted a nationwide, virtual case vignette-based survey among French dermatologists. Participants reviewed four case vignettes. Data on management suggestions from the dermatologists were collected using questionnaires embedded in the case vignettes. Ninety dermatologists reviewed 356 virtual case vignettes. Of these, 99.4% contained a randomly generated profile describing a virtual psoriasis patient who had responded to current therapy but required treatment optimization, and 23.0% involved mild psoriasis treated with topical treatments, 77.0% involved moderate-to-severe psoriasis treated by conventional systemics or biologics, 59.9% involved psoriasis that had moderate or severe-to-very severe impact on HRQoL, 48.6% had joint involvement, and 58.7% had persistent skin lesions. For virtual patients with mild psoriasis involving topical treatments alone (n = 82), the dermatologists suggested switching or modifying the treatment in 81.7% of cases, most commonly by initiating conventional oral systemic therapy. For virtual cases with moderate-to severe psoriasis involving conventional oral systemic therapies (N = 90), the most common suggestion was to switch treatment (54.4% of cases), most notably to biologic therapy. Switching to a second-line or subsequent-line biologic was the most common suggestion for virtual cases already undergoing biologic therapy. Overall, modifying the existing treatment was suggested for 31.5% of the virtual cases, most notably by introducing new treatment combinations (biologics with conventional systemic and/or topical treatments). Impact on HRQoL, joint involvement, and persistent skin lesions were identified as factors influencing dermatologist decision-making (p < 0.001). Our findings provide valuable insights into the current decision-making practices of French dermatologists when optimizing the management of mild or moderate-to-severe psoriasis.