Therapeutic inertia (TI) is the inability of physicians to initiate a more aggressive treatment in patients who need them. It is more common among patients with chronic disease and may be secondary to physician-related factors, patient-related factors, or healthcare system-related factors.

This study aims to explore the evidence behind TI in the management of moderate to severe psoriasis and to determine the factors that contribute to it.

An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN from their inception up to June 2023. Cross-sectional studies that looked into TI in moderate to severe psoriasis and discussed the factors that lead to it were included. The review was limited to peer-reviewed journals written in English. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted.

3256 records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4-35.6%. The occurrence of TI in psoriasis is largely caused by physician-related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient-related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system-related factors were not directly explored.

The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.