Introduction
 
Psoriasis is a non-life threatening but highly debilitating disease that currently has no cure. Traditional treatments often either lack efficacy or are effective but have very poor side-effect profiles, limiting them to use in severe disease only. However, the market is growing as disease awareness increases through the approval and marketing of novel biologic treatments in this indication.
 

 
Scope
 
Overview of disease including detailed epidemiology, physician estimated diagnosis rates and severity split
 
Breakdown of treatment trends in the following markets: US, Japan, France, Germany, Italy, Spain and the UK
 
Survey of PCPs and dermatologists in the major markets to capture the treatment of the ranging severities of psoriasis, from mild to severe patients
 
Review of current treatment options and clinical debate including comments from key opinion leaders
 
Highlights
 
Psoriasis is currently under diagnosed with an average of 55% of sufferers diagnosed by a physician. However, awareness of the debilitating nature of this disease is increasing, driven by the introduction of high profile biologic brands into the market.
 

 
Topical treatments such as calcipotriol and corticosteroids still dominate psoriasis treatment, leaving a gap for the moderate severity patient not effectively treated by this group, but not severe enough for an expensive or toxic systemic treatment.
 

 
Current and pipeline biologic brands are differentiated from selected traditional brands by their perceived superior efficacy, side-effect profile, dosing frequency and ability to treat comorbidities.
 

 
Reasons to Purchase
 
Differentiate your product in the crowded psoriasis market through an understanding of physician perceptions of key product brands
 
Identify unmet needs and the most important attributes to prescribing physicians for steroidal, biologic and vitamin derivative treatment classes
 
Forecast product usage across the seven major markets based on estimated treatment class patient numbers

TABLE OF CONTENTS
 
CHAPTER 1 EXECUTIVE SUMMARY 3
 
Scope of the analysis 3
 
Datamonitor insight into the psoriasis market 4
 
Psoriasis is currently under diagnosed, but awareness is increasing with the introduction of high-profile biologic brands. 4
 
Topical treatments such as calcipotriol and corticosteroids still dominate psoriasis treatment, leaving a gap for the moderate severity patient not effectively treated by this group, but not severe enough for an expensive or toxic systemic treatment. 5
 
Current and pipeline biologic brands are differentiated from selected traditional brands by their perceived superior efficacy, side-effect profile, dosing frequency and ability to treat comorbidities. 5
 
CHAPTER 2 INTRODUCTION AND SCOPE 14
 
2.1 Coverage of the Stakeholder Insight Survey 14
 
Section 1 – Epidemiology 14
 
Section 2 – Treatment patterns 14
 
Section 3 – Key prescribing influences 14
 
Section 4 – Treatment outcomes and patient compliance 15
 
Section 5 – Pipeline therapies and treatment challenges 15
 
2.1.1 Country level ‘treatment trees’ 17
 
CHAPTER 3 COUNTRY TREATMENT TREES 18
 
US 20
 
Japan 24
 
France 28
 
Germany 32
 
Italy 36
 
Spain 40
 
UK 44
 
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION 48
 
4.1 Disease definition and classification 48
 
Plaque (vulgaris) 48
 
Guttate 48
 
Inverse 48
 
Pustular 49
 
Erythrodermic 49
 
Diagnostic criteria 49
 
4.2 Epidemiology of psoriasis 50
 
US 51
 
Japan 52
 
Europe 52
 
France 52
 
Germany 52
 
Italy 53
 
Spain 53
 
UK 53
 
4.3 Patient segmentations 54
 
Age 54
 
Gender 56
 
4.4 Comorbidities, complications and risk factors 56
 
Lifestyle 57
 
Trauma 58
 
Infections 58
 
Other autoimmune diseases 58
 
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS 59
 
5.1 Presentation and diagnosis 59
 
Diagnosis rates and awareness 59
 
Disease severity 60
 
5.2 Treatment rates 62
 
5.3 Treatment options 64
 
Non-pharmacological 65
 
Phototherapy 66
 
Pharmacological 67
 
Treatment class options 68
 
Topical formulations 69
 
5.5 Off-label prescriptions 70
 
5.6 Treatment guidelines 73
 
Awareness of guidelines 74
 
Adherence to guidelines 75
 
CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS 77
 
6.1 Prescribing trends 77
 
6.2 Factors influencing physician decision making 81
 
Safety vs. efficacy 83
 
Company representative visits 83
 
Other stakeholders 84
 
6.3 Brand perception 85
 
Brand Mapping 87
 
Awareness by physician specialty 90
 
Biologic prescribing influences 92
 
Biologics brand map 94
 
Amevive 96
 
Raptiva 99
 
Enbrel 101
 
Remicade 104
 
Steroids 106
 
Steroid prescribing influences 106
 
Elocon 110
 
Vitamin derivatives 112
 
Vitamin derivative prescribing influences 112
 
Dovonex 114
 
Tazorac 118
 
Soriatane 120
 
Traditional treatments brand map 123
 
CHAPTER 7 IMPROVING TREATMENT OUTCOMES 124
 
7.1 Treatment outcomes 124
 
PASI score 124
 
PASI: issues and debates 125
 
Patients reaching desired outcome 130
 
7.2 Patient compliance 132
 
Unmet needs 137
 
Physician/patient education 137
 
Patient perspective 137
 
Cost reduction 140
 
Therapeutic unmet needs 141
 
7.3 New product development 142
 
7.3.1 Awareness 142
 
BG-12 (fumarate derivative) 142
 
Avandia (rosiglitazone) 143
 
PsorBan (topical cyclosporine) 144
 
Oral tazarotene 145
 
Protopic (tacrolimus) 146
 
Elidel (pimecrolimus) 147
 
Humira (adalimumab) 149
 
Impact 149
 
Pharmacist perspectives 149
 
CHAPTER 8 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS 151
 
Dr Liz Horn, PhD – National Psoriasis Foundation 151
 
Dr Steven Feldman, MD - Professor of Dermatology, Pathology and Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem, North Carolina 158
 
Charles N. Ellis, MD - Professor and Associate Chair, Department of Dermatology, University of Michigan Medical, Ann Arbor, US 165
 
Dr Michiko Haida, MD, PhD - Professor of Allergy and Immunology, Hanzoumon Hospital, Tokyo 175
 
APPENDIX A 178
 
Epidemiology 179
 
Clinical trial data 179
 
APPENDIX B 181
 
Physician research methodology 181
 
Brand Map Interpretation 181
 
RX-Days 185
 
Physician sample breakdown 186
 
APPENDIX C 187
 
THE SURVEY QUESTIONNAIRE 187
 
Section 1: Epidemiology 187
 
Section 2: Treatment patterns 190
 
Section 3: Key prescribing and brand influences 196
 
Section 4: Treatment outcomes and patient compliance 198
 
Section 5: Pipeline therapies 202
 
Disclaimer 203