Understanding Patient Preferences in Psoriasis, With Andrew Blauvelt, MD, MBA

As a wave of new oral therapies approaches regulatory review for moderate-to-severe plaque psoriasis (PsO), a better understanding is needed of what factors may affect patient preference toward different modalities of treatment.

HCPLive caught up with Andrew Blauvelt, MD, MBA, dermatologist, Blauvelt Consulting, at the 2026 American Academy of Dermatology (AAD) Annual Meeting held in Denver, Colorado, from March 27-31, to learn more about how the field is coming to better understand and support patient preferences.

In this conversation, Blauvelt pushed back on what he described as a reflexive tendency to assume that the availability of once-daily oral options will automatically translate into patient demand. The reality, he noted, is considerably more nuanced. Across several published preference studies he reviewed, the direction of patient preference varied substantially depending on disease, severity, injection characteristics, and country of origin.1-3

In 1 study comparing patients with atopic dermatitis and psoriasis on the question of route-of-administration preference, the 2 groups diverged: atopic dermatitis patients favored oral therapy, while psoriasis patients expressed a preference for injectable treatment.1 A second psoriasis-specific study found that disease severity modulated preference within the same patient population — those with more moderate disease leaned toward pills, while patients with more severe disease preferred injections.2 The implication, Blauvelt noted, is that 2 studies conducted in the same disease reached different directional conclusions depending on how the question was asked and which patients were enrolled.

Geographic context introduced additional variation. A study conducted in Japan found a clear preference for oral therapy, while a comparable study conducted in Germany yielded the opposite result, with German patients favoring injections.1,2 And a further study found that what mattered most was not simply whether a treatment was injectable, but what kind of injection it was: patients preferred shots when they were infrequent — monthly or less — and not painful, but shifted toward pills when injections were more frequent or associated with discomfort.

Blauvelt framed these findings as relevant context for interpreting the clinical landscape now emerging around envudeucitinib, zasocitinib, and icotrokinra, each of which offers once-daily or twice-daily oral dosing and carries efficacy data approaching or overlapping with injectable biologics in some measures. The case for oral therapy is real, he argued, but it is not universal — and the patients most likely to benefit from the shift to pills may be those with moderate disease, those averse to injections for logistical or geographic reasons, and those in clinical settings where biologic prescribing remains limited. For patients with more severe disease who are already on well-tolerated, infrequent injectable biologics, the calculus may be less straightforward than the narrative around the oral pipeline sometimes suggests.

Blauvelt’s disclosures include Abbvie, Almirall, Alumis, Amgen, AnaptysBio, Apogee Therapeutics, Arcutis Biotherapeutics, Eli Lilly, Incyte, Janssen, LEO Pharma, Lipidio Pharma, Novartis, Oruka Therapeutics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, Takeda, and UCB.

References

1. Royeck S, et al. Treatment preferences among systemic therapy-naïve patients with atopic dermatitis or psoriasis in Germany: a multicentre study. Dermatol Ther (Heidelb). 2025. doi:10.1007/s13555-025-01615-8

2. Komine M, et al. A discrete choice experiment on oral and injection treatment preferences among moderate-to-severe psoriasis patients in Japan. J Dermatol. 2023;50:766-777. doi:10.1111/1346-8138.16746

3. Bolt T, Kobayashi H, Mahlich J. Patient and physician preferences for therapy characteristics for psoriasis: a discrete choice experiment in Japan. Pharmacoecon Open. 2019;3(2):255-264. doi:10.1007/s41669-018-0104-1