A Smartphone Application Supporting Patients With Psoriasis Improves Adherence to Topical Treatment

A Randomized Controlled Trial

M.T. Svendsen; F. Andersen; K.H. Andersen; A. Pottegård; H. Johannessen; S. Möller; B. August; S.R. Feldman; K.E. Andersen

Disclosures

The British Journal of Dermatology. 2018;179(5):1062-1071. 

In This Article

Abstract and Introduction

Abstract

Background: Adherence to topical psoriasis treatments is low, which leads to unsatisfactory treatment results. Smartphone applications (apps) for patient support exist but their potential to improve adherence has not been systematically evaluated.

Objectives: To evaluate whether a study–specific app improves adherence and reduces psoriasis symptoms compared with standard treatment.

Methods: We conducted a randomized controlled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once–daily medication [calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app intervention (n = 68) groups. In total, 122 patients (91%) completed the 22–week follow–up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS–PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits.

Results: Intention–to–treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/BD cutaneous foam than those in the nonintervention group at week 4 (65% vs. 38%, P = 0·004). The intervention group showed a greater LS–PGA reduction than the nonintervention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance.

Conclusions: This RCT demonstrates that the app improved short–term adherence to Cal/BD cutaneous foam treatment and psoriasis severity.

Introduction

Psoriasis is a chronic inflammatory disease affecting 2–4% of the Western population.[1] Psoriasis has a severe impact on quality of life[2,3] and creates a large socioeconomic burden.[4,5] Mild–to–moderate psoriasis can be treated with topical corticosteroid preparations,[6–8] but adherence rates to these treatments are generally low and present a barrier for treatment success.[9]

Previous studies including patients with psoriasis treated with topical corticosteroids in Western dermatology outpatient clinics have reported nonadherence rates from 8 to 88%.[10] Patients tend to self–report higher adherence rates than those obtained by objective measurements,[11,12] therefore it is recommended to measure adherence objectively by using either an electronic monitor (gold standard) or medication weight.[13,14] Two studies have reported interventions improving adherence to topical corticosteroid treatment. One study tested the effects of weekly self–reporting of psoriasis status to a webpage for 1 year.[15] That intervention improved adherence to topical fluocinonide ointment in the intervention group relative to the control group. The other study did not use a control group and reported that 2 months of an individualized multifactorial patient–supporting intervention provided at dermatology clinics led to improved adherence rates relative to baseline.[16] There is a new and growing field of eHealth interventions for adherence improvement;[17] however, there is a little evidence for their effectiveness.[18]

The aim of this study is to test whether the use of a study–specific smartphone application (app, Table 1) for 4 weeks improves short–term adherence to a recommended standard topical treatment regimen with calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam (LEO Pharma, Ballerup, Denmark). As secondary outcomes, we also evaluated (i) short (week 4) and long–term (week 8 and 26) psoriasis severity [Lattice System Physician's Global Assessment (LS–PGA)[19,20]] and (ii) quality of life [Dermatology Life Quality Index (DLQI)[21])].

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