patients with psoriasis and psoriatic arthritis (PsA) Previous/current medical care Psoriasis, n = 735 (%) PsA, n = 270 (%) Seen an HCP in the previous 12 months 57.4 85.6 Type of HCP seen most often for psoriasis and PsA Dermatologist 56.9 22.2 Rheumatologist 1.5 38.1 General medicine or primary care physician 30.2 28.1 Other/unknown 5.1 10.0 Not seen an HCP in the previous 12 months 42.6 14.4 Ever seen a dermatologist (for psoriasis) or rheumatologist (for PsA) 80.0 68.0 Reasons for not seeing an HCP Symptoms were not bad enough 34.1 32.4 No symptoms 19.9 20.6 Did not think an HCP could help 18.9 23.5 Current treatment working 10.6 2.9 Cost or lack of insurance 7.0 8.8 Unable to get appointment 1.0 2.9 HCP healthcare provider MAPP Survey Results from US Patients and Physicians 91 patients were adverse effects and the need for laboratory monitoring (Fig. 2a). Patients most commonly discontinued conventional oral therapy because of safety and tolerability issues, or lack or loss of effectiveness (Fig. 3a). Similarly, the main reasons for dermatologists and rheumatologists not initiating or maintaining conventional oral therapy in psoriasis and PsA patients were related to long-term safety and tolerability concerns (Fig. 3b, c). In addition, one quarter of rheumatologists also cited lack of effectiveness as the main reason for not initiating conventional oral therapy for their PsA patients. Of the physicians who did not prescribe conventional oral therapy, because of patient refusal or concerns, the most common patient concerns were related to long-term safety, tolerability, and lifestyle modifications. Fig. 2 Most common patientreported reasons for conventional oral therapy (a) and biologic therapy (b) being burdensome Table 4 Current treatment utilization in patients with moderate to severe psoriasis Therapy Reported by psoriasis patients, n = 1005 (%)a Reported by dermatologists, n = 101 (%)b Topical therapy 40.0 79.1 Conventional oral therapy 5.8 12.7 Biologic therapy 7.9 35.8 a Patients were asked to self-rate the severity of their disease on a 1–10 scale (1–3 for mild, 4–7 for moderate, 8–10 for severe) b Treatment utilization is reported for patients with moderate to severe psoriasis, as estimated by dermatologists Table 5 Current treatment utilization in patients with psoriatic arthritis (PsA) Therapy Reported by PsA patients, n = 270 (%) Reported by dermatologists, n = 101 (%)a Reported by rheumatologists, n = 100 (%)a Topical therapy 53.0 56.8 52.9 Conventional oral therapy 24.1 22.9 57.1 Biologic therapy 25.9 46.9 52.7 a Treatment utilization is reported for patients with moderate to severe PsA, as estimated by dermatologists or rheumatologists 92 M. G. Lebwohl et al. 3.6.2 Biologic Therapy Among 90 patients who were using injectable biologics at the time of the survey, anxiety and fear related to injections and side effects were the most common reasons that 27 % cited for finding them burdensome (Fig. 2b). As with conventional oral therapy, patients most commonly discontinued biologic therapy because of safety and tolerability concerns, and lack or loss of effectiveness; however, 13.7 % of patients also reported cost as a reason for discontinuing biologic therapy (Fig. 4a). Broad use of biologic agents was reported by three quarters of rheumatologists versus one third of dermatologists, yet 82.2 % of dermatologists (versus 99.0 % of rheumatologists) said they would initiate and manage biologic therapy themselves if their patient were a candidate. The main reasons that dermatologists and rheumatologists cited for not initiating or continuing biologic therapy were related to long-term safety and tolerability issues, as well as cost (Fig. 4b, c). 3.7 Satisfaction with Current Treatment Options The majority of psoriasis and PsA patients were somewhat satisfied or very satisfied with the effectiveness of conventional oral therapy (56.9 and 69.5 %, respectively) or biologic therapy (77.7 and 83.5 %, respectively), with more PsA patients than psoriasis patients reporting satisfaction. However, 33.9 % of psoriasis patients and 39.7 % of PsA patients reported being dissatisfied with the longterm safety of conventional oral therapy. Dissatisfaction with the long-term safety of biologic therapy was reported by 31.8 % of psoriasis patients and 25.2 % of PsA patients. Overall, 31.3 % of psoriasis patients and 40.7 % of PsA patients reported that their primary goals of therapy, including keeping symptoms at bay, reducing itching, and decreasing flaking, were not met with their current treatment. In general, more physicians than patients reported satisfaction with treatment effectiveness. Among dermatologists, 76.3 % reported satisfaction with conventional oral therapy effectiveness and 99.0 % reported satisfaction with Fig. 4 Most common reasons for patients discontinuing biologic therapy (a) and for dermatologists