Adherence to CAL/BDP PAD-Cream Influences Treatment Effectiveness and Preference in Scalp Psoriasis Under Real-Life Conditions: Results from the Prospective, Multicenter, Observational PRO-SCALP Study

Scalp psoriasis is often associated with poor adherence to topical therapy. A novel formulation of calcipotriol and betamethasone dipropionate based on polyaphron dispersion (CAL/BDP PAD-cream) showed improved outcomes and satisfaction in the PRO-SCALP study, particularly in patients with high adherence. We evaluated how adherence to CAL/BDP PAD-cream influences patients- and clinicians-reported outcomes and treatment preferences in mild-to-moderate scalp psoriasis under real-life conditions in Europe. PRO-SCALP patients reported their adherence level using a visual analogue scale (VAS). Outcomes were compared between low- and high-adherence subgroups. Among 252 patients, 59.9% reported high adherence (VAS 80–100). Older patients and those with moderate disease reported high adherence (both p < 0.05). High-adherent patients reported higher scores in the Treatment Satisfaction Questionnaire for Medication Version 9, for Convenience of use (p = 0.0019) and Global Satisfaction (p = 0.0166) domains, and in the Psychosocial Effects of Scalp Psoriasis Questionnaire (p = 0.0004) at week 8. Both adherence subgroups showed significant reductions in the scalp Worst Itch Numeric Rating Scale (WI-NRS), scalp-modified Psoriasis Area and Severity Index (S-mPASI), and Scalpdex scores (all p < 0.0001 vs. baseline), although high-adherent patients achieved greater improvements in WI-NRS (p < 0.0001), S-mPASI (p = 0.0153), and the Scalpdex Symptoms domain (p = 0.001) than low-adherent. Each 10% increase in adherence corresponded to a 0.10- and 0.35-point reduction in S-mPASI and WI-NRS (both p < 0.05) at week 8. Scalp-Physician Global Assessment success rates were comparable in low- vs. high-adherence subgroups (65.0% vs. 70.5%; p = 0.3633). Sleep quality improved significantly in both subgroups (p < 0.0001). High adherence was associated with higher Patient Preference Questionnaire scores (p = 0.0012), better Cream Usability Scalp Psoriasis Questionnaire ratings (p = 0.0455) and greater product consumption (p < 0.0001), despite similar once-a-day usage. High adherence to CAL/BDP PAD-cream was associated with greater effectiveness, satisfaction, preference, and QoL. While patients with low adherence still benefited, maximizing adherence is key for optimal real-world outcomes in scalp psoriasis. ClinicalTrials.gov identifier NCT05811234. Scalp psoriasis is a long-lasting disease that greatly impairs quality of life. Due to the presence of hair, the scalp is a hard area to treat. Topical medicines are the first treatment choice. However, many patients struggle to follow them because of inconvenience, cosmetic concerns, side effects, or dissatisfaction, which often leads to poor disease control. One of the most recommended topical treatments is the combination of calcipotriol, a vitamin D analog, and betamethasone dipropionate, a corticosteroid, (CAL/BDP). Based on a new polyaphron dispersion (PAD) technology, CAL/BDP PAD-cream is a novel formulation designed to make treatment easier to use, more cosmetically acceptable, and effective, while maintaining similar safety and tolerability than previous formulations. A recent study (PRO-SCALP), evaluating CAL/BDP PAD-cream in patients with mild-to-moderate scalp psoriasis, showed improvements in treatment outcomes and satisfaction, especially in patients with high adherence (patients that followed the treatment as prescribed). Hence, in this subgroup analysis, patients with low and high adherence were compared. Both groups experienced meaningful improvements, but patients with high adherence presented stronger reductions in itch and scalp lesions, higher satisfaction, and greater preference for CAL/BDP PAD-cream. They also reported greater improvements in quality of life and psychosocial well-being, while sleep improved similarly across both groups. Overall, this study further shows that CAL/BDP PAD-cream is an effective, user-friendly treatment for scalp psoriasis and demonstrates that high adherence leads to better outcomes, underlining the key role of following treatment as prescribed by the healthcare professional for the best control of scalp psoriasis.