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386 CLINICAL REPORT Beliefs About Medicines in Patients with Psoriasis Treated with Methotrexate or Biologics: A Cross-sectional Survey Study Marisol E. OTERO 1 , Juul M. P. A. VAN DEN REEK 1 , Peter C. M. VAN DE KERKHOF 1 , Jorre S. MERTENS 1 , Marieke M. B. SEYGER 1 , Wietske KIEVIT 2 and Elke M. G. J. DE JONG 1,3 1 Department of Dermatology, 2 Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, and 3 Radboud University, Nijmegen, The Netherlands Methotrexate (MTX) and biologics are frequently used treatments for psoriasis. Exploring patients’ beliefs about their treatment may help to elucidate patients’ attitudes towards these therapies. A cross-sectional survey was conducted using the Beliefs about Medici- nes Questionnaire-Specific (BMQ-Specific) in patients treated with methotrexate or biologics. BMQ-Specific scores (Necessity and Concerns scales) were calcula- ted and patients were classified as “accepting”, “in- different”, “ambivalent” or “sceptical” towards their treat­ment. Biologics users scored higher on the Neces- sity scale than did methotrexate users. Both groups had lower Concerns scores than Necessity scores. A high Necessity scale was associated with a low Psoria- sis Area and Severity Index score in both groups and long treatment duration in the methotrexate group. Although this study cannot make a direct comparison, it was observed that most patients on biologics could be classified as “accepting” (59%), and most patients on MTX could be classified as “indifferent” (47%). In conclusion, the BMQ-Specific is useful to identify pa- tients with a sceptical, ambivalent or indifferent pro- file. These profiles may negatively influence patient’s attitude towards their medication. Key words: psoriasis; beliefs about medicines; biologics; metho­trexate; BMQ; cross-sectional. Accepted Dec 13, 2018; E-published Dec 13, 2018 Acta Derm Venereol 2019; 99: 386–392. Corr: Marisol E. Otero, Department of Dermatology 370, Radboud Uni- versity Medical Center, PO Box 9101, NL-6500 HB Nijmegen, The Nether- lands. E-mail: [email protected] P soriasis is a chronic, immune-mediated inflammatory skin disease, affecting 2–4% of the population in western countries (1). Moderate-to-severe psoriasis is usually treated with systemic therapies, such as metho­ trexate (MTX) or biologics. Since psoriasis is a chronic disease, patients need long-term treatment to control the disease. MTX is a well-known conventional systemic therapy for continuous treatment of moderate to severe plaque psoriasis; biologics are often the next step in the treatment when conventional systemic therapies fail or are contraindicated (2, 3). It is important that patients use these therapies adequately in order to obtain disease doi: 10.2340/00015555-3108 Acta Derm Venereol 2019; 99: 386–392 SIGNIFICANCE Methotrexate and biologics are the most-used systemic treatments for psoriasis. This study describes the beliefs (necessity to use, and concerns about these treatments) of patients using these treatments, and factors associated with these beliefs. Patients using biologics were found to have a higher necessity to use the treatment than those using methotrexate. A high necessity was associated with a low Psoriasis Area and Severity Index in both treatment groups, and with longer treatment duration in the metho­ trexate group. Most patients using biologics could be classi- fied as “accepting” the treatment, and most patients using methotrexate as “indifferent” to the treatment. Identifying patients with a sceptical, ambivalent or indifferent profile could be useful, because these profiles could negatively in- fluence patient’s attitude towards their medication. control. It is well-known that the attitudes of patients towards medicines, including adherence, are influenced by their beliefs about the prescribed medication (4–9). The Beliefs about Medicines Questionnaire Specific (BMQ-Specific) is the most-used tool to assess these beliefs, expressed as Necessity and Concerns scores, about the prescribed medication for a specific disease. The use of this questionnaire in other chronic diseases has shown that patients who perceive high Necessity and low Concerns towards their medication are more likely to use their treatment as recommended by the prescriber (4). Assessing the balance between patients’ Necessities and Concerns about their prescribed medication helps elucidate the attitude (positive or negative) of patients towards their medication (4, 10). Because MTX and biologics are among the most im- portant systemic treatments for psoriasis in daily clinical practice, it is crucial to explore the beliefs of patients regarding these treatments. In addition, identifying the factors that may affect these beliefs is important in order to search for specific interventions (e.g. counselling) to prevent treatment failure. The objective of this study was therefore to explore the beliefs about medicines in patients with psoriasis treated with MTX or biologics, using the BMQ-Specific questionnaire (10). In addition, this study sought determinants that were associated with either high Necessity or low Concerns scores. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.