Nonadherence to Treatment and Patient-Reported Outcomes of Psoriasis During the COVID-19 Epidemic: A Web-Based Survey

Qiaolin Wang,1– 3 Yan Luo,1– 3 Chengzhi Lv,4 Xuanwei Zheng,1– 3 Wu Zhu,1– 3 Xiang Chen,1– 3 Minxue Shen,1– 3,5 Yehong Kuang1– 3 1Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, People’s Republic of China; 2National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, People’s Republic of China; 3Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha 410008, People’s Republic of China; 4Department of Psoriasis, Dalian Dermatosis Hospital, Dalian, Liaoning 116021, People’s Republic of China; 5Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410078, People’s Republic of ChinaCorrespondence: Yehong Kuang; Minxue ShenXiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People’s Republic of ChinaEmail yh_927@126.com; shenmx1988@csu.edu.cnPurpose: The COVID-19 epidemic has caused difficulties in continuous treatment for patients with chronic diseases and resulted in nonadherence to treatment and adverse health outcomes. This study aimed to investigate the associations of nonadherence to treatment with patient-reported outcomes of psoriasis during the COVID-2019 epidemic.Methods: A cross-sectional study among Chinese patients with psoriasis was conducted through a web-based questionnaire survey during 25 Feb 2020 and 6 Mar 2020. Demographic and clinical data, nonadherence to treatment, and patient-reported outcomes were collected. The outcomes included deterioration of the disease condition, perceived stress, and symptoms of anxiety and depression. Logistic regression was used to investigate the associations.Results: A total of 926 questionnaires were collected. A total of 634 (68.5%) reported nonadherence to treatment, and worse adherence was found among patients receiving systemic treatment (adjusted odds ratio [AOR]: 2.67; 95% CI: 1.40– 5.10) and topical treatment (AOR: 4.51; 95% CI: 2.66– 7.65) compared to biological treatment. Nonadherence to treatment (less than two weeks and more than two weeks) was significantly associated with deterioration of psoriasis (aOR: 2.83 to 5.25), perceived stress (AOR: 1.86 to 1.57), and symptoms of anxiety (AOR: 1.42 to 1.57) and depression (AORs: 1.78). Subgroup analysis by treatment showed consistent results in general.Conclusion: Nonadherence to treatment was associated with the aggravation of psoriasis conditions, perceived stress, and symptoms of anxiety and depression.Keywords: psoriasis, coronavirus disease 2019, patient-reported outcome, treatment adherence