Study Highlights Barriers in Access to Biologics Among Psoriasis Patients

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In this analysis, disparities associated with race, old age, socioeconomic differences, and rural residence were highlighted as examples.

There are significant barriers and disparities related to race, older age, socioeconomic status, cost and insurance, residence in rural areas, and knowledge insufficiencies that can diminish levels of access to biologic therapies among patients with psoriasis, according to recent findings.1

These results had been drawn from new research assessing current literature to comprehensively highlight any existing barriers to access or gaps in awareness of biological treatments for psoriasis patients. This research was led by Vincent Wan, from the faculty of medicine at University of British Columbia, Vancouver in Canada.

The investigators acknowledged the value in defining existing barriers to the acquisition of biologic options among those who are biologic-naïve patients given potential disparities. They highlighted recent data from the US National Health and Wellness Survey in 2017 indicating that 59% of insured patients diagnosed with mild-to-severe psoriasis had not been treated for their disease in the prior year.2

“To identify existing knowledge gaps and facilitate a comprehensive understanding of the barriers to biologics use in psoriatic patients, a scoping review was conducted to synthesize existing research,” Wan and colleagues wrote.

Background and Methods

The research team began their search of the Embase, MEDLINE, and Web of Science databases, from their study’s inception up to March 2023. They implemented several different search terms connected to “barriers,” “psoriasis,” and “biologics,” contacting previous trial investigators if additional data was deemed to be necessary.

Following their database searches, the team gathered research based upon several criteria for inclusion. Specifically, the studies had to be cross-sectional and perform the following:

  • Evaluate the beliefs and viewpoints of individuals with moderate-to-severe psoriasis who have not implemented biologic treatments,
  • Assess various perspectives among healthcare providers who have prescribed such therapies for those with moderate-to-severe psoriasis.

The investigators would also include retrospective chart review studies that included quantitative data assessing the connection between use of biologic therapies and different factors at the prescriber, organizational, patient, medication, and external levels, with such factors having been identified in prior literature as barriers to the adoption of new drugs. The team assigned 3 reviewers to screen articles independently, utilizing the Covidence systematic review software.

During the times when sufficient data was not included within abstracts, the research team would carry out full-text reviews to decide eligibility. Any disagreements were resolved through discussion. Additionally, references from the included studies were manually reviewed to ensure no relevant studies were missed.

A single reviewer would then collect data, before the information was validated by another through the use of a standardized extraction form including data such as authors, identified barriers/disparities, title, year of publication, trial design, location of research, subject demographics, and major conclusions.


There had first been a pool of 2684 articles, though a later screening by the research team resulted in a selection of 18 studies which fully met the team’s criteria for inclusion. An additional 2 studies were found using reverse-citation searching and these were also added to the team’s research synthesis.

The investigators stratified the emerging themes of these articles systematically into 5 main subcategories: prescriber-related, patient-related, organizational, medicine-related, and external environmental factors.

A series of adequate care barriers were reported by the research team, including:

  • Specialist shortages,
  • Lack of awareness among healthcare practitioners,
  • Discrimination of patients,
  • Lack of standardized diagnosis and treatment tools,
  • High biologic therapy costs.

The team noted that these findings also highlighted barriers and disparities connected to patient age, socioeconomic status, racial group, rural residence, cost, insurance, and lack of knowledge. These were acknowledged as possible limits to access of biologics for individuals with psoriasis.

“Given the exploratory nature of this scoping review, no critical appraisal was conducted to evaluate the strength and impact of findings across studies,” they wrote. “We were unable to quantitatively assess the impact of each proposed barrier due to the significant heterogeneity that existed in the studies included.”


  1. Wan V, Habibi A, Mukovozov I, et al. (2024), Disparities and barriers to the access of biologics in moderate-to-severe adult psoriasis. Int J Dermatol.
  2. Armstrong AW, Koning JW, Rowse S, Tan H, Mamolo C, Kaur M. Under-treatment of patients with moderate to severe psoriasis in the United States: analysis of medication usage with health plan data. Dermatol Ther. 2017; 7(1): 97–109.