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Jin JQ, Cronin A, Roberts-Toler C, Yeroushalmi S, Hadeler E, Spencer RK, Elhage KG, Gondo G, Wallace EB, Reddy SM, Han G, Kaffenberger J, Davis MS, Hakimi M, Scher JU, Armstrong AW, Bhutani T, McLean RR, Liao W. Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: A 2015-2022 prospective cohort analysis of the CorEvitas psoriasis registry. J Am Acad Dermatol 2023; 89:974-983. [PMID: 37495173 DOI: 10.1016/j.jaad.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Psoriasis patients with poor therapeutic response to multiple biologic agents are not well-characterized. OBJECTIVE To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic. METHODS This prospective cohort analysis evaluated patients in the multicenter CorEvitas Psoriasis Registry who initiated their first biologic between 2015 and 2020 and were followed for ≥24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued ≥2 biologics of different classes, each used for ≥90 days, due to inadequate efficacy) and GR (continued use of first biologic for ≥2 years) patients. RESULTS One thousand thirty-nine patients were analyzed (490 GR [47.2%], 65 MBF [6.3%]). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior nonbiologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter 2 variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was Tumor necrosis factor-α inhibitor to IL-17 inhibitor use. LIMITATIONS Biologic adherence between visits was not evaluated. CONCLUSION Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.
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Affiliation(s)
- Joy Q Jin
- School of Medicine, University of California San Francisco, San Francisco, California; Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | | | - Samuel Yeroushalmi
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Edward Hadeler
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Riley K Spencer
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | | | - Soumya M Reddy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, New York
| | - George Han
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Mitchell S Davis
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, New York
| | - April W Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California.
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Tada Y, Morita A, Yamanaka K, Kono M, Imafuku S, Okubo Y, Yamazaki F, Kawamura T, Itakura A, Ohtsuki M. Real-world retention rates and effectiveness of secukinumab in psoriasis: Results from a multicenter cohort study (RAILWAY). J Dermatol 2023; 50:1415-1426. [PMID: 37615243 DOI: 10.1111/1346-8138.16926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Psoriasis is a chronic, immune-mediated inflammatory skin disease with a high negative impact on patient's quality of life. Secukinumab, the first interleukin 17A inhibitor, has been used for the systemic treatment of psoriasis, but its long-term, real-world retention rates in Japan have not been fully investigated. In this multicenter, noninterventional, retrospective chart review study, the retention rate of secukinumab and its effectiveness among patients with psoriasis in Japan was evaluated up to 5 years. Data of patients who received secukinumab after December 26, 2014, were collected from medical charts obtained from seven sites, all certified for biologics use by the Japanese Dermatological Association. Patient characteristics, secukinumab retention, factors affecting secukinumab retention, reason for drug discontinuation, and effectiveness data were collected. The primary end point was secukinumab retention rate at week 52. A total of 123 patients were included in the analysis. Of these, 27 patients discontinued secukinumab by week 52, yielding a 78.0% (95% confidence interval, 69.6-84.4) retention rate at week 52. For patients whose Psoriasis Area and Severity Index (PASI) score was available, mean ± standard deviation PASI at baseline and at week 52 were 9.21 ± 7.37 and 1.4 ± 2.6, respectively. During the entire study period, "insufficient response" was the most common reason for discontinuation, and "history of biologics use" was a factor significantly associated with secukinumab discontinuation (hazard ratio, 1.72; p = 0.018). This study demonstrates the real-world retention rate and effectiveness of secukinumab in patients with psoriasis in Japan for up to 5 years and provides clinical insights into psoriasis treatment strategies.
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Affiliation(s)
- Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Michihiro Kono
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Fumikazu Yamazaki
- Department of Dermatology, Tokai University School of Medicine, Isehara, Japan
| | - Taisuke Kawamura
- Immunology, Hepatology & Dermatology Medical Franchise Department, Medical Division, Novartis Pharma K.K., Tokyo, Japan
| | - Asako Itakura
- Immunology, Hepatology & Dermatology Medical Franchise Department, Medical Division, Novartis Pharma K.K., Tokyo, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Marcombes C, Penso L, Weill A, Dray-Spira R, Zureik M, Sbidian E. Persistence of second-line biologics in psoriasis after first-line biologic failure: a nationwide cohort study from the French health insurance database (SNDS). Br J Dermatol 2023; 189:561-568. [PMID: 37479503 DOI: 10.1093/bjd/ljad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Many biologics are available for psoriasis and have been compared in real-life studies based on their persistence (i.e. time between initiation and discontinuation). However, after first-line biologic failure, data are lacking on the choice of second-line biologic among the four available classes [tumour necrosis factor inhibitors (TNFi); interleukin (IL)-12/IL-23 inhibitor (IL-12/IL-23i); IL-17 inhibitors (IL-17i); and IL-23 inhibitors (IL-23i)]. OBJECTIVES To compare the long-term persistence of available second-line biologics in psoriasis according to prior exposure. METHODS This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to a hospital discharge database. Participants were adults with psoriasis, defined as having at least two prescriptions of a topical vitamin D derivative within a 2-year period, with initiation of a second-line biologic between 1 January 2015 and 31 December 2021. We included patients who initiated a second-line biologic directly after first-line discontinuation (i.e. without a 'washout' period). The end of follow-up was 30 June 2022. Discontinuation was defined as > 90 days without filling a prescription for the same treatment after the period covered by the previous prescription. Comparison of persistence by biologic class involved using propensity score-weighted Cox models (inverse probability treatment weighting) and adjustment of specific systemic nonbiologics (time-dependent variables). RESULTS We included 8693 patients [mean (SD) age 50 (14) years; 50.5% male]; 2824 (32.5%) started TNFi, 1561 (18.0%) IL-12/IL-23i, 2707 (31.1%) IL-17i and 1601 (18.4%) IL-23i. Overall, 1- and 3-year persistence rates were 60% and 30%, respectively. After weighting and adjustment, persistence was longer with IL-12/IL-23i [weighted hazard ratio (HRw) 0.68, 95% confidence interval (CI) 0.62-0.76)], IL-17i (HRw 0.70, 95% CI 0.64-0.78) and IL-23i (HRw 0.36, 95% CI 0.31-0.42) than TNFi, except after first-line IL-17i treatment, with no difference between IL-12/IL-23i, IL-17i and TNFi second-line persistence. Persistence was longer with IL-23i as a second-line treatment than IL-12/IL-23i (HRw 0.53, 95% CI 0.44-0.63) and IL-17i (HRw 0.51, 95% CI 0.44-0.60), regardless of first-line treatment, with no difference seen between IL-12/IL-23i and IL-17i (HRw 0.97, 95% CI 0.87-1.09). CONCLUSIONS This real-life study suggests the longer persistence of IL-23i than TNFi, IL-17i and IL-12/IL-23i as second-line treatment for psoriasis. Persistence rates for all biologics remained low at 3 years.
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Affiliation(s)
- Clarisse Marcombes
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Laetitia Penso
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Emilie Sbidian
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
- Inserm, Centre d'investigation clinique 1430, Hôpital Henri Mondor, Creteil, France
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France
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Kishimoto M, Komine M, Kamiya K, Sugai J, Kuwahara A, Mieno M, Ohtsuki M. Drug Survival of Tumor Necrosis Factor-Alpha Inhibitors and Switched Subsequent Biologic Agents in Patients with Psoriasis: A Retrospective Study. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00932-0. [PMID: 37204609 DOI: 10.1007/s13555-023-00932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION This study aimed to retrospectively examine the drug survival of tumor necrosis factor (TNF)-alpha inhibitors and switched subsequent biologic agents after discontinuation of TNF inhibitors. METHODS This real-world setting study was conducted at a single academic center. We included patients who were treated with adalimumab (n = 111), certolizumab pegol (n = 12), and infliximab (n = 74) at Jichi Medical University Hospital from 1 January 2010 to 31 July 2021. RESULTS No significant differences were noted in drug survival between the three TNF inhibitors. The 10-year drug survival rate for adalimumab and infliximab was 14% and 18%, respectively. Of the patients who discontinued TNF inhibitors for any reason (n = 137), 105 chose biologics as their subsequent treatment. The subsequent biologics included 31 cases of TNF inhibitors (adalimumab in 20, certolizumab pegol in 1, and infliximab in 10), 19 of interleukin-12/23 inhibitor (ustekinumab), 42 of interleukin-17 inhibitors (secukinumab in 19, brodalumab in 9, and ixekizumab in 14) and 13 of interleukin-23 inhibitors (guselkumab in 11, risankizumab in 1, and tildrakizumab in 1). Cox proportional hazards analysis for the subsequent drugs in cases of discontinuation due to inadequate efficacy revealed that female sex was a predictor of drug discontinuation (hazard ratio 2.58, 95% confidence interval 1.17-5.70) and that taking interleukin-17 inhibitors rather than TNF inhibitors was a predictor of drug persistence (hazard ratio 0.37, 95% confidence interval 0.15-0.93). CONCLUSIONS Interleukin-17 inhibitors may be a favorable option for patients who need to switch from TNF inhibitors due to inadequate efficacy. However, this study is limited by the small number of cases and its retrospective design.
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Affiliation(s)
- Megumi Kishimoto
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Junichi Sugai
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Aya Kuwahara
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Jin JQ, Spencer RK, Reddy V, Bhutani T, Liao W. Clinical Utility of Deucravacitinib for the Management of Moderate to Severe Plaque Psoriasis. Ther Clin Risk Manag 2023; 19:413-423. [PMID: 37223005 PMCID: PMC10202110 DOI: 10.2147/tcrm.s388324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Psoriasis is a chronic, immune-mediated skin condition with significant detriments to physical/mental health. While systemic therapies are available for the treatment of moderate-to-severe psoriasis, patients can experience therapeutic failure, loss of efficacy, or medical contraindications that require other therapeutic options. Objective With the recent approval of deucravacitinib, a first-in-class TYK2 small molecule inhibitor administered orally for psoriasis patients, we reviewed data from randomized controlled trials (RCTs) to synthesize its clinical utility. To our knowledge, this is the first systematic review and meta-analysis of deucravacitinib comparing its clinical efficacy to placebo in psoriasis. Methods A literature search was conducted in PubMed (MEDLINE), Embase, and the Cochrane Central Register of Controlled Trials to identify RCTs studying deucravacitinib in human patients with moderate-to-severe psoriasis. Results One placebo-controlled Phase II RCT and two placebo-controlled/active-comparator Phase III RCTs were included for review. Patients (N=1953) treated with deucravacitinib 6 mg daily showed marked improvement in disease severity (Psoriasis Area and Severity Index (PASI), static Physician Global Assessment (sPGA) and quality-of-life outcomes compared to patients administered comparator (apremilast) and placebo. Clinical improvement given deucravacitinib was noted for scalp psoriasis but not fingernail psoriasis. Meta-analysis (deucravacitinib, n=888; placebo, n=466) comparing rates of clearance (sPGA 0/1) demonstrated superior efficacy of deucravacitinib compared to placebo (odds ratio, 12.87; 95% confidence interval, 8.97-18.48; χ2=4.08, I2=51%). Deucravacitinib was well-tolerated, with similar rate of occurrence and type of adverse events reported among patients treated with placebo or apremilast at Week 12-16. No cardiovascular events, serious infections, or lab abnormalities were noted. Conclusion Deucravacitinib possesses good efficacy, with no report of safety concerns associated with prior JAK inhibitors used for psoriasis. Meta-analysis demonstrated deucravacitinib's superiority compared to placebo, indicating its promising clinical utility. Further studies are needed to observe long-term safety and efficacy, and to compare deucravacitinib to existing treatments.
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Affiliation(s)
- Joy Q Jin
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - Riley K Spencer
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - Vidhatha Reddy
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
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Ivanov RA, Murashkin NN. Administration Details of Genetically Engineered Biologic Drug (Ustekinumab) in Children with Psoriasis and Comorbid Metabolic Syndrome or in Case of Previous Biological Therapy Failure: Case Studies. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i5.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background. Psoriasis is a chronic immune-mediated disease with multifactorial nature. It often requires administration of genetically engineered biologic drugs. They have a number of features and risks that depend on various factors. The results of ustekinumab administration as a drug of choice in patients with comorbid metabolic syndrome in a child with Down syndrome, as well as a case of inefficacy of previous biologic therapy with TNFα inhibitors are considered. Clinical cases description. Two clinical cases of ustekinumab administration in children with severe psoriasis have been described. In the first case, we had to choose systemic therapy for the child suffering from Down syndrome and having complex comorbid background: obesity and steatohepatitis. The second case was interesting due to the family history of psoriasis in the patient, who received methotrexate for a long time, and then etanercept with subsequent loss of efficacy and severe disease aggravation without any pathogenetic therapy. Conclusion. Ustekinumab is the favorable genetically engineered biologic drug (according to the studies results and the clinical cases data) for children with severe psoriasis who have comorbid pathologies and who require the change in biologic agent due to its inefficacy.
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Affiliation(s)
- R. A. Ivanov
- National Medical Research Center of Children’s Health; Central State Medical Academy of Department of Presidential Affairs
| | - N. N. Murashkin
- National Medical Research Center of Children’s Health; Sechenov First Moscow State Medical University; Central State Medical Academy of Department of Presidential Affairs
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Oh S, Choi S, Yoon HS. Available Alternative Biologics and Disease Groups Influence Biologic Drug Survival in Patients with Psoriasis and Psoriatic Arthritis. Ann Dermatol 2022; 34:321-330. [PMID: 36198623 PMCID: PMC9561298 DOI: 10.5021/ad.22.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/21/2022] [Accepted: 04/24/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Factors other than efficacy and safety could influence the survival of biologics in patients with psoriasis. Little is known about whether different disease groups affect drug survival of biologics or not. OBJECTIVE This study aimed to investigate whether the availability of alternative biologics and disease groups could influence drug survival of biologics approved for psoriasis and psoriasis arthritis (PsA). METHODS A nationwide population-based retrospective cohort study was conducted using the Health Insurance and Review Assessment data in Korea between January 2009 and August 2019. RESULTS The drug survival analysis included 5,634 biologic episodes. Ustekinumab was the most frequently prescribed drug (n=2,488, 44.2%). Multivariable time-dependent Cox regression analysis showed that higher age, female sex, no comorbidity, concomitant cyclosporine or acitretin use, biologic-experienced and use of tumor necrosis factor (TNF)-α inhibitors were predictors of drug discontinuation. PsA was a predictor of drug persistence, particularly for TNF-α inhibitors. Ustekinumab and adalimumab discontinuation significantly increased after introducing secukinumab and ustekinumab, respectively. CONCLUSION The availability of alternative biologics and disease groups affect biologic drug survival in patients with psoriasis and PsA.
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Affiliation(s)
- Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sungjun Choi
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Merola JF, Kavanaugh A, Lebwohl MG, Gniadecki R, Wu JJ. Clinical Efficacy and Safety of Psoriasis Treatments in Patients with Concomitant Metabolic Syndrome: A Narrative Review. Dermatol Ther (Heidelb) 2022; 12:2201-2216. [PMID: 36008702 PMCID: PMC9515257 DOI: 10.1007/s13555-022-00790-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Metabolic syndrome (MetS) is well recognized as a frequent comorbidity of psoriasis with important implications for efficacy and safety of psoriasis treatment. The presence of concomitant MetS is associated with decreased efficacy response to biologic treatment for psoriasis in observational studies. In post hoc analyses of clinical trial data, the anti–IL-23p19 antibody tildrakizumab appears to maintain efficacy in patients compared to those without MetS; no published subgroup analyses by MetS status are yet available for other biologics. However, there is some evidence that obese patients have decreased psoriasis treatment efficacy with biologics with certain mechanisms of action relative to overweight patients. This confounds interpretation of the effect of MetS due to the association between MetS and body weight. Because of the association between MetS and cardiovascular risk, treatment of psoriasis in patients with concomitant MetS requires special consideration for cardiovascular safety and attention to potential for exacerbation of MetS and related conditions, including nonalcoholic fatty liver disease. Additional studies are needed to clarify the risks for treatment failure and cardiovascular safety concerns in patients with psoriasis and concomitant MetS.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
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9
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Comparison of the Efficacy and Safety of Biologics (Secukinumab, Ustekinumab, and Guselkumab) for the Treatment of Moderate-to-Severe Psoriasis: Real-world Data from a Single Korean Center. Biomedicines 2022; 10:biomedicines10051058. [PMID: 35625795 PMCID: PMC9139155 DOI: 10.3390/biomedicines10051058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
Biologics are important treatment options for psoriasis; however, direct comparison of their efficacy, safety, and drug survival is insufficient in clinical practice. This retrospective single-center study aimed to compare the efficacy, safety, and drug survival of three commonly used psoriasis biologics (secukinumab, ustekinumab, and guselkumab) and identify the factors affecting drug survival in actual clinics in Korea. We enrolled 111 patients with moderate to severe psoriasis and for at least 56 weeks of follow-up; among these, 27, 23, and 61 were administered secukinumab, ustekinumab, and guselkumab, respectively. All groups were comparable with respect to their baseline characteristics. Secukinumab showed a rapid response, and guselkumab was superior in terms of a long-term response and complete remission compared with other biologics, while ustekinumab showed a lower efficacy compared with other biologics. All three biologics had a favorable and similar safety profile; however, allergic reactions and latent tuberculosis were more common with secukinumab and ustekinumab, respectively. Guselkumab was the most sustained biologic, and the survival rates of secukinumab and ustekinumab were similar. Drug survival was remarkably shorter in female patients and those with hypertension. Introduction of new biologics emerged as a negative factor for drug survival in clinical settings.
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10
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Pina Vegas L, Penso L, Claudepierre P, Sbidian E. Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database. JAMA Dermatol 2022; 158:513-522. [PMID: 35319735 PMCID: PMC8943623 DOI: 10.1001/jamadermatol.2022.0364] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
Importance Treatment options for psoriasis (PsO) and psoriatic arthritis (PsA) have evolved significantly throughout the era of biologics. Clinical trials are inadequate to assess the relative long-term efficacy of biologics and are often insufficient regarding safety. Objectives To assess the long-term persistence of different biologic classes to treat PsO and PsA. Design, Setting, and Participants This nationwide cohort study involved the administrative health care database of the French health insurance scheme linked to the hospital discharge database. All adults with PsO and PsA who were new users of biologics (not in the year before the index date) from January 1, 2015, to May 31, 2019, were included and followed up through December 31, 2019. Patients hospitalized for PsA in the PsO cohort and for PsO in the PsA cohort in the year before the index date were excluded. Data were analyzed from June 1 to October 31, 2021. Main Outcomes and Measures Persistence was defined as the time from biologic therapy initiation to discontinuation and was estimated using the Kaplan-Meier method. Comparison of persistence by biologic class involved using propensity score-weighted Cox proportional hazards regression models and adjustment on specific systemic nonbiologics (time-dependent variables). Results A total of 16 892 patients with PsO were included in the analysis (mean [SD] age, 48.5 [13.8] years; 9152 men [54.2%] men). Of these, 10 199 patients (60.4%) started therapy with a tumor necrosis factor (TNF) inhibitor; 3982 (23.6%), with an interleukin 12 and interleukin 23 (IL-12/23) inhibitor; and 2711 (16.0%), with an interleukin 17 (IL-17) inhibitor. An additional 6531 patients with PsA (mean [SD] age, 49.1 [12.8] years; 3565 [54.6%] women) were included; of these, 4974 (76.2%) started therapy with a TNF inhibitor; 803 (12.3%), with an IL-12/23 inhibitor; and 754 (11.5%), with an IL-17 inhibitor. Overall 3-year persistence rates were 40.9% and 36.2% for PsO and PsA, respectively. After inverse probability of treatment weighting and adjustment, the IL-17 inhibitor was associated with higher persistence compared with the TNF inhibitor for PsO (weighted hazard ratio [HR], 0.78 [95% CI, 0.73-0.83]) and PsA (weighted HR, 0.70 [95% CI, 0.58-0.85]) and compared with the IL-12/23 inhibitor for PsA (weighted HR, 0.69 [95% CI, 0.55-0.87]). No difference between the IL-17 inhibitor and IL-12/23 inhibitor for PsO was noted. The IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor for PsO (weighted HR, 0.76 [95% CI, 0.72-0.80]), with no difference observed for PsA. Conclusions and Relevance The findings of this cohort study suggest that IL-17 inhibitors are associated with higher treatment persistence than the TNF inhibitor for PsO and PsA. Interleukin 17 inhibitors were also associated with higher persistence than the IL-12/23 inhibitor for PsA, with no difference for PsO. However, the persistence rates of all biologics remained globally low at 3 years.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France
| | - Laetitia Penso
- EpiDermE, Université Paris Est Créteil, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, St Denis
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique 1430, Hôpital Henri Mondor, Créteil, France
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
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11
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Adalimumab with methotrexate versus adalimumab monotherapy in psoriasis: First-year results of a single-blind randomized controlled trial. J Invest Dermatol 2022; 142:2375-2383.e6. [DOI: 10.1016/j.jid.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/07/2023]
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12
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Lam Hoai XL, De Maertelaer V, Simonart T. Real-world adherence to topical therapies in patients with moderate acne. JAAD Int 2021; 2:109-115. [PMID: 34409359 PMCID: PMC8362275 DOI: 10.1016/j.jdin.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Real-life data on topical treatments in daily practice in patients with moderate acne are poorly characterized. Objective To investigate the drug survival of topical treatments administered to patients with moderate acne in a daily practice. Methods Survival analysis was performed on subjects (Belgian university hospital and private practice outpatient dermatology patients) with moderate acne who received topical therapies according to the current published guidelines. Results A total of 1160 treatment series (1029 patients) were included, including benzoyl peroxide (BPO, n = 93), azelaic acid (n = 246), adapalene (n = 254), a fixed combination of adapalene 0.1% and BPO 2.5% (A/BPO, n = 264), and a fixed combination of clindamycin 1.2% and tretinoin 0.025% gel (Clin-RA, n = 303). The calculated overall median treatment duration of all drugs was 2 months. The probability of treatment discontinuation after only 3 months was 50%. Overall, the drugs were discontinued for the following reasons: controlled acne (9%), side effects (9%), ineffectiveness (52%), combination of side effects and ineffectiveness (3%), and other reasons (1%). Overall, 27% patients were lost to follow-up. Limitations The post hoc study design and generalizability limit interpretation of the data. Conclusion Overall, the median treatment duration of topical anti-acne therapies was short (2 months). The main reason for discontinuation was ineffectiveness.
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Affiliation(s)
- Xuân-Lan Lam Hoai
- Department of Dermatology, St Pierre - Brugmann - Hôpital Universitaire Des Enfants Reine Fabiola (HUDERF) University Hospitals, Université Libre de Bruxelles, Belgium
| | - Viviane De Maertelaer
- Department of Biostatistics, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Simonart
- Department of Dermatology, Delta Hospital, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Université Libre de Bruxelles, Brussels, Belgium
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13
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Ozkok Akbulut T, Topaloglu Demir F, Oguz Topal I, Kara Polat A, Karadag AS, Aslan Kayiran M, Ozkur E, Kıvanc Altunay I. Drug survival and predictor factors for discontinuation of methotrexate in psoriasis: a real-life multicenter study. Int J Dermatol 2021; 60:1140-1147. [PMID: 34013975 DOI: 10.1111/ijd.15628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Drug survival is useful to evaluate long-term drug performance in daily practice. The aim of this study was to evaluate drug survival for methotrexate (MTX) monotherapy in patients with plaque-type psoriasis. METHODS We reviewed 3,512 follow-up charts of patients with psoriasis at five tertiary referral centers between January 2012 and January 2020. We analyzed baseline data and treatment outcomes of patients under MTX monotherapy. Drug survival was analyzed using Kaplan-Meier and Cox regression analyses. RESULTS Patients with psoriasis who were treated with MTX monotherapy were enrolled (N = 649). The median duration of drug survival was 15 months (95% CI: 13.2-16.8). The overall drug survival rate was 54.7%, 17.4%, and 8% after 1, 3, and 5 years, respectively. The main reasons for discontinuation were adverse effects (n = 209, 32.2%) and inefficacy (n = 105, 15.6%). Based on multivariate Cox regression analysis, the presence of nausea/vomiting (HR: 2.01, 95% CI: 1.49-2.71; P < 0.001) was observed as a statistically significant risk factor for drug discontinuation. Age over 50 years (HR: 0.68, 95% CI: 0.48-0.97; P = 0.03) and using MTX dose ≥15 mg/weekly were positive predictors for drug survival (HR: 0.72, 95% CI: 0.54-0.95; P = 0.02). CONCLUSIONS The average drug survival of MTX was 15 months. MTX is still the first-line treatment of moderate-to-severe plaque psoriasis, as highlighted in guidelines. To prevent premature discontinuation, physicians need to look at the response time of at least 16-24 weeks, especially when a stepwise dose increment is used. The presence of nausea/vomiting seemed to be associated with an approximately twofold risk of discontinuation.
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Affiliation(s)
- Tugba Ozkok Akbulut
- Department of Dermatology and Venereology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Filiz Topaloglu Demir
- Department of Dermatology and Venereology, Faculty of Medicine, University of Medipol, Istanbul, Turkey
| | - Ilteris Oguz Topal
- Department of Dermatology and Venereology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology and Venereology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology and Venereology, Faculty of Medicine, University of Medeniyet, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Melek Aslan Kayiran
- Department of Dermatology and Venereology, Faculty of Medicine, University of Medeniyet, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Ozkur
- Department of Dermatology and Venereology, University of Health Sciences, Sisli Training and Research Hospital, Istanbul, Turkey
| | - Ilknur Kıvanc Altunay
- Department of Dermatology and Venereology, University of Health Sciences, Sisli Training and Research Hospital, Istanbul, Turkey
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14
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Lima ECD, Boza JC, Palominos PE, Xavier RM, Cestari TF. Survival of immunobiological drugs in psoriasis: preliminary data from a Tertiary Hospital experience in Southern Brazil. An Bras Dermatol 2021; 96:376-379. [PMID: 33789818 PMCID: PMC8178523 DOI: 10.1016/j.abd.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Elis Costa de Lima
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Juliana Catucci Boza
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Penélope Esther Palominos
- Department of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Machado Xavier
- Department of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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15
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Chatzimichail G, Günther J, Ständer S, Thaçi D. Drug survival of secukinumab, ustekinumab, and certolizumab pegol in psoriasis: a 2-year, monocentric, retrospective study. J DERMATOL TREAT 2021; 33:1749-1753. [DOI: 10.1080/09546634.2020.1854428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Giannis Chatzimichail
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Julia Günther
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sascha Ständer
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
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16
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Geale K, Lindberg I, Paulsson EC, Wennerström ECM, Tjärnlund A, Noel W, Enkusson D, Theander E. Persistence of biologic treatments in psoriatic arthritis: a population-based study in Sweden. Rheumatol Adv Pract 2021; 4:rkaa070. [PMID: 33409449 PMCID: PMC7772250 DOI: 10.1093/rap/rkaa070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives TNF inhibitors (TNFis) and IL inhibitors are effective treatments for PsA. Treatment non-persistence (drug survival, discontinuation) is a measure of effectiveness, tolerability and patient satisfaction or preferences in real-world clinical practice. Persistence on these treatments is not well understood in European PsA populations. The aim of this study was to compare time to non-persistence for either ustekinumab (IL-12/23 inhibitor) or secukinumab (IL-17 inhibitor) to a reference group of adalimumab (TNFi) treatment exposures in PsA patients and identify risk factors for non-persistence. Methods A total of 4649 exposures of adalimumab, ustekinumab, and secukinumab in 3918 PsA patients were identified in Swedish longitudinal population-based registry data. Kaplan–Meier curves were constructed to measure treatment-specific real-world risk of non-persistence and adjusted Cox proportional hazards models were estimated to identify risk factors associated with non-persistence. Results Ustekinumab was associated with a lower risk of non-persistence relative to adalimumab in biologic-naïve [hazard ratio (HR) 0.48 (95% CI 0.33, 0.69)] and biologic-experienced patients [HR 0.65 (95% CI 0.56, 0.76)], while secukinumab was associated with a lower risk in biologic-naïve patients [HR 0.65 (95% CI 0.49, 0.86)] but a higher risk of non-persistence in biologic-experienced patients [HR 1.20 (95% CI 1.03, 1.40)]. Biologic non-persistence was also associated with female sex, axial involvement, recent disease onset, biologic treatment experience and no psoriasis. Conclusion Ustekinumab exhibits a favourable treatment persistency profile relative to adalimumab overall and across lines of treatment. The performance of secukinumab is dependent on biologic experience. Persistence and risk factors for non-persistence should be accounted for when determining an optimal treatment plan for patients.
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Affiliation(s)
- Kirk Geale
- Quantify Research, Stockholm, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - E Christina M Wennerström
- Janssen-Cilag AB, Solna, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Wim Noel
- Janssen Pharmaceutica NV, Beerse, Belgium
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17
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Graier T, Salmhofer W, Jonak C, Weger W, Kölli C, Gruber B, Sator PG, Prillinger K, Mlynek A, Schütz-Bergmayr M, Richter L, Ratzinger G, Painsi C, Selhofer S, Häring N, Wippel-Slupetzky K, Skvara H, Trattner H, Tanew A, Inzinger M, Tatarski R, Bangert C, Ellersdorfer C, Lichem R, Gruber-Wackernagel A, Hofer A, Legat F, Schmiedberger E, Strohal R, Lange-Asschenfeldt B, Schmuth M, Vujic I, Hoetzenecker W, Trautinger F, Saxinger W, Müllegger R, Quehenberger F, Wolf P. Biologic drug survival rates in the era of anti-interleukin-17 antibodies: a time-period-adjusted registry analysis. Br J Dermatol 2020; 184:1094-1105. [PMID: 33289075 PMCID: PMC8248155 DOI: 10.1111/bjd.19701] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/22/2022]
Abstract
Background Drug survival rates reflect efficacy and safety and may be influenced by the availability of alternative treatment options. Little is known about time‐dependent drug survival in psoriasis and the effect of increasing numbers of biologic treatment options. Objectives To determine whether drug survival is influenced by the availability of treatment options and by factors such as gender, psoriatic arthritis or previous biologic treatment. Methods This observational, retrospective, multicentre cohort study analysed data from patients registered in the Austrian Psoriasis Registry (PsoRA) who were treated with biologics between 1 January 2015 and 30 November 2019. Results A total of 1572 patients who received 1848 treatment cycles were included in this analysis. The highest long‐term Psoriasis Area and Severity Index improvement was observed after treatment with ixekizumab, followed by ustekinumab and secukinumab, adalimumab and etanercept. Overall, ustekinumab surpassed all other biologics in drug survival up to 48 months. However, when adjusted for biologic naïvety, its superiority vanished and drug survival rates were similar for ixekizumab (91·6%), secukinumab (90·2%) and ustekinumab (92·8%), all of them superior to adalimumab (76·5%) and etanercept (71·9%) at 12 months and beyond. Besides biologic non‐naïvety (2·10, P < 0·001), the introduction of a new drug such as secukinumab or ixekizumab (relative hazard ratio 1·6, P = 0·001) and female gender (1·50, P = 0·019) increased the risk of treatment discontinuation overall, whereas psoriatic arthritis did not (1·12, P = 0·21). Conclusions The time‐dependent availability of drugs should be considered when analysing and comparing drug survival. Previous biologic exposure significantly influences drug survival. Women are more likely to stop treatment.
What is already known about this topic?
Female gender and previous biologic exposure have been discussed as predictors for decreased drug survival in patients with psoriasis, but it remains unknown whether a time‐dependent increased availability of treatment options alters biologic drug survival.
What does this study add?
The increased availability of alternative biologic treatments over time leads to an elevated risk for treatment discontinuation overall; therefore, drug survival analysis has to be time adjusted. Moreover, the study reveals that the impact of previous biologic treatment on drug survival is tremendous and confirms worse drug survival in female patients.
Linked Comment: Gniadecki. Br J Dermatol 2021; 184:996–997.
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Affiliation(s)
- T Graier
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - W Salmhofer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - W Weger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - C Kölli
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - B Gruber
- Department of Dermatology and Venereology, Hospital of Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - P G Sator
- Department of Dermatology, Hietzing Hospital, Vienna, Austria
| | - K Prillinger
- Department of Dermatology and Venereology, University Hospital St Pölten, St Pölten, Austria
| | - A Mlynek
- Department of Dermatology, Hospital of Elisabethinen, Linz, Austria
| | - M Schütz-Bergmayr
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| | - L Richter
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - G Ratzinger
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Painsi
- Department of Dermatology and Venereology, State Hospital, Klagenfurt, Austria
| | - S Selhofer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - N Häring
- Department of Dermatology and Venereology, Federal Academic Teaching Hospital, Feldkirch, Austria
| | | | - H Skvara
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - H Trattner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Inzinger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - R Tatarski
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - C Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Ellersdorfer
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - R Lichem
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Gruber-Wackernagel
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Hofer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - F Legat
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - E Schmiedberger
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - R Strohal
- Department of Dermatology and Venereology, Federal Academic Teaching Hospital, Feldkirch, Austria
| | | | - M Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - I Vujic
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - W Hoetzenecker
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| | - F Trautinger
- Department of Dermatology and Venereology, University Hospital St Pölten, St Pölten, Austria
| | - W Saxinger
- Department of Dermatology and Venereology, Hospital of Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - R Müllegger
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - P Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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18
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Yayli S, Baykal Selcuk L, Aksu Arica D, Bayrak S. Drug survival of biologic treatments in Turkish patients with psoriasis. Dermatol Ther 2020; 33:e13917. [DOI: 10.1111/dth.13917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Savaş Yayli
- Faculty of Medicine, Department of Dermatology Karadeniz Technical University Trabzon Turkey
| | - Leyla Baykal Selcuk
- Faculty of Medicine, Department of Dermatology Karadeniz Technical University Trabzon Turkey
| | - Deniz Aksu Arica
- Faculty of Medicine, Department of Dermatology Karadeniz Technical University Trabzon Turkey
| | - Simay Bayrak
- Faculty of Medicine, Department of Dermatology Karadeniz Technical University Trabzon Turkey
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19
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Gulliver W, Penney M, Power R, Gulliver S, Montmayeur S, Burge R. Moderate-to-severe plaque psoriasis patients treated with ixekizumab: early real-world outcomes and adverse events. J DERMATOL TREAT 2020; 33:354-360. [PMID: 32319327 DOI: 10.1080/09546634.2020.1755009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Data on real-world experiences for patients treated with ixekizumab is currently limited.Objectives: Describe characteristics of ixekizumab-treated psoriasis patients and provide evidence of clinical outcomes using disease severity scores Body Surface Area (BSA) and Psoriasis Area and Severity Index (PASI) in the real world.Methods: Chart review was performed for adult patients treated with ixekizumab at a single Canadian dermatology clinic (February 2017-August 2018). The cohort was stratified into responders (patients who remained on ixekizumab) and non-responders (patients who discontinued ixekizumab). Subgroup analyses were performed for responders to assess clinical improvement stratified by previous biologic exposure.Results: Thirty-eight patients were included (mean observational time 32 weeks). At baseline, mean PASI and BSA were 10.8 and 11.6%, respectively. Mean changes in PASI and BSA were -7.8 and -6.7%, respectively, at week 4. PASI 100 was achieved in 70% of patients. Significant differences in mean change of BSA were seen between bio-naïve and bio-experienced patients.Conclusion: This analysis represents the first investigation of early clinical outcomes in a small cohort of Canadian patients treated with ixekizumab. Overall, complete and rapid skin clearance was observed. Future studies including more patients and longer follow-up time are crucial to confirm these findings.
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Affiliation(s)
- Wayne Gulliver
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.,Newlab Clinical Research Inc, St. John's, Canada
| | | | - Rebecca Power
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.,Newlab Clinical Research Inc, St. John's, Canada
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,Division of Pharmaceutical Sciences, Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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20
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Sun C, Xia J. Treatment of psoriasis: janus kinases inhibitors and biologics for the interleukin-23/Th17 axis. Minerva Med 2020; 111:254-265. [PMID: 32166932 DOI: 10.23736/s0026-4806.20.06460-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
With the discovery of the IL-23 / Th17 axis, the treatment of psoriasis has entered a new era. The aim of this study was to explore the progress of biologics and janus kinases (JAK) inhibitors targeting IL-23/Th17 axis in the treatment of psoriasis. review of English-language article was performed. Search terms included IL-17, IL-23, biologics, monoclonal antibodies, neutralizing antibodies, JAK, inhibitors, Psoriasis Area Severity Index and psoriasis. Data were selected from two phase 2 clinical trials; and nine phase 3 randomized, double-blind clinical trials; and other clinical trials. This review analyzes skin lesion clearance and major adverse reactions of 9 mAbs including mirikizumab and bimekizumab. At the same time, the research progress and prospects of three non-IgG small molecule biologics are analyzed too. This paper also compares the efficacy and limitations of biologics targeting the IL-23/Th17 axis with non-biologics acting on the JAK-signal transducer and activator of transcription pathway. The IL-17A/F inhibitors and non-IgG small molecule biologics that are being studied will bring a revolutionary development to the treatment of psoriasis. Topical application of JAK inhibitors can not only achieve the purpose of treating psoriasis, but also reduce the amounts of systemic medication, and reduces side effects. Each drug has its own indication, and the effect of the drug can be better achieved by selecting the indication for the drug.
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Affiliation(s)
- Chunlei Sun
- Department of Dermatology, The Second Affiliated Hospital of JiLin University, Changchun, China
| | - Jianxin Xia
- Department of Dermatology, The Second Affiliated Hospital of JiLin University, Changchun, China -
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21
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Carlet C, Bichard D, Richard MA, Mahé E, Saillard C, Brenaut E, Dupuy A, Misery L, Villani A, Jullien D, Puzenat E, Nardin C, Aubin F, Groupe de Recherche sur le Psoriasis de la Société Française de Dermatologie. Long-Term Infliximab Treatment in Psoriasis Patients: A National Multicentre Retrospective Study. Dermatol Res Pract 2020; 2020:2042636. [PMID: 32231699 PMCID: PMC7085387 DOI: 10.1155/2020/2042636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although infliximab (IFX) has been available since 2005, there are very little data on the long-term drug survival of infliximab in real-life. OBJECTIVE Our aim was to identify and describe psoriasis patients treated with IFX for longer than 6 years. METHODS Psoriasis patients treated with IFX for longer than 6 years were retrospectively included. Demographic and clinical data were collected in May 2018. RESULTS Between January 2005 and December 2012, 43 patients were maintained on IFX for 6 years or longer. IFX was introduced as a 4.5 line of systemic therapy. The mean duration of IFX treatment was 8.5 years (6-12). In May 2018, 30 patients (70%) were still maintained on IFX at 4-6 mg/kg every 8-10 weeks with an efficiency of about 100%. IFX was stopped in 13 patients (30%) mainly for loss of efficacy in 6 patients (46%). Three patients developed solid cancer including bladder cancer, lung cancer, and prostate cancer. Limitation. Retrospective study. CONCLUSION We report the efficacy and safety of IFX maintained for up to 12 years in psoriasis patients. The long-term use of IFX was associated with a high BMI confirming the critical role of weight-based dosing for this drug.
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Affiliation(s)
| | | | | | - Emmanuel Mahé
- Dermatology Dpt, CH Victor Dupouy, Argenteuil, France
| | | | | | | | | | - Axel Villani
- Dermatology Dpt, Hôpital Edouard Herriot, Lyon, France
| | - Denis Jullien
- Dermatology Dpt, Hôpital Edouard Herriot, Lyon, France
| | - Eve Puzenat
- Dermatology Dpt, CHU Besançon, Besançon, France
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22
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Shalom G, Cohen AD, Feldhamer I, Comaneshter D, Freud T, Pavlovsky L. Drug survival in patients with psoriasis is associated with the availability of biologic medications. J Eur Acad Dermatol Venereol 2020; 34:1524-1528. [PMID: 31953883 DOI: 10.1111/jdv.16205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug survival rates in patients with psoriasis had been described extensively. Different survival rates of TNF-α inhibitors (TNFIs), ustekinumab and secukinumab were reported. OBJECTIVES To investigate drug survival rates of TNFIs, ustekinumab and secukinumab, with particular emphasis on the difference between ustekinumab and secukinumab. METHODS Survival analysis was performed in patients with moderate-to-severe psoriasis who received adalimumab, infliximab, etanercept, ustekinumab and secukinumab treatment in 2002-2018, using the Clalit Health Services database. Stratified analysis was performed according to biologic treatment lines. Multivariate analysis was performed adjusting for demographic variables, calendar year, metabolic syndrome, psoriatic arthritis, biologic treatment line, biologic naivety, co-administration of oral treatments and previous oral systemic treatment exposure. RESULTS Among 1459 patients treated with 3070 biologic medication courses, ustekinumab had a significantly higher crude survival as compared with TNFIs and secukinumab. The mean drug survival of ustekinumab, adalimumab, etanercept, infliximab and secukinumab was 43.5 (CI: 39.7-47.2), 38.2 (CI: 34.8-41), 33.9 (CI: 30.8-37.1), 28.2 (CI: 22.5-33.8) and 17.1 (CI: 15.6-18.6) months, respectively, with significant statistical differences for all comparisons (P < 0.001). The differences between ustekinumab and secukinumab were not significant following adjustment to factors that included treatment line (hazard rate 1.16, CI: 0.93-1.43). CONCLUSION Different drug survival rates between ustekinumab and secukinumab are determined by the treatment line and calendar year, reflecting the availability of biologic medications, and not only by the biologic attributes of each medication.
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Affiliation(s)
- G Shalom
- Clalit Health Services, Yavne, Israel.,Division of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A D Cohen
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Feldhamer
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - D Comaneshter
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - T Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - L Pavlovsky
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Liu LF, Chen JS, Gu J, Xu JH, Jin HZ, Pang XW, Wang G, Yu C, Song ZQ, Guo ZP, Li W, Lai W, Cui PG, Chen M, Fang H, Lyu CZ, Li YZ, Sun Q, Xie HF, Liu XM, Gao XH, Shi YL, Zhao NQ, Zhang W, Zheng M. Etanercept biosimilar (recombinant human tumor necrosis factor-α receptor II: IgG Fc fusion protein) and methotrexate combination therapy in Chinese patients with moderate-to-severe plaque psoriasis: a multicentre, randomized, double-blind, placebo-controlled trial. Arch Dermatol Res 2019; 312:437-445. [DOI: 10.1007/s00403-019-02024-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 02/08/2023]
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24
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van der Schoot LS, van den Reek JMPA, Groenewoud JMM, Otero ME, Njoo MD, Ossenkoppele PM, Mommers JM, Koetsier MIA, Berends MAM, Arnold WP, Peters B, Andriessen MPM, Den Hengst CW, Kuijpers ALA, de Jong EMGJ. Female patients are less satisfied with biological treatment for psoriasis and experience more side-effects than male patients: results from the prospective BioCAPTURE registry. J Eur Acad Dermatol Venereol 2019; 33:1913-1920. [PMID: 31177583 DOI: 10.1111/jdv.15733] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/17/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Female sex has been reported as a predictor for treatment discontinuation with biological therapies for psoriasis, although reasons remain unclear. It can be hypothesized that lower satisfaction with biological treatment in women might add to the lower drug survival rates. OBJECTIVES To identify possible differences in satisfaction with biological treatment between female and male patients using the Treatment Satisfaction Questionnaire for Medication (TSQM). METHODS Data of psoriasis patients treated with biologics were obtained from the prospective, multicentre, daily-practice BioCAPTURE registry. Longitudinal TSQM data were analysed by linear mixed models. Relevant patient characteristics were incorporated as possible confounding factors. Post hoc analysis of adverse events was performed in order to investigate differences between sexes. RESULTS We included 315 patients with 396 corresponding treatment episodes (137 adalimumab, 90 etanercept, 137 ustekinumab, 24 secukinumab and 8 infliximab). Almost forty per cent of the patients were female. Women had significantly lower baseline PASI scores (P = 0.01). Longitudinal analyses demonstrated lower TSQM scores for 'side-effects' (P = 0.05) and 'global satisfaction' (P = 0.01) in female patients compared with male patients over 1 year of treatment. Women reported more relevant adverse events in the context of biologic treatment compared to men (rate ratio 1.79; P < 0.001), with more fungal (rate ratio 2.20; P = 0.001) and herpes simplex infections (rate ratio 3.25; P = 0.005). CONCLUSIONS This study provides a prospective, longitudinal analysis of treatment satisfaction with biologics in female and male patients with psoriasis. Women were slightly less satisfied with treatment regarding side-effects and global satisfaction. Differences in treatment satisfaction and side-effects might add to the fact that women discontinue biological treatments more often.
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Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J M M Groenewoud
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M E Otero
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M D Njoo
- Department of Dermatology, Ziekenhuisgroep Twente, Almelo/Hengelo, the Netherlands
| | - P M Ossenkoppele
- Department of Dermatology, Ziekenhuisgroep Twente, Almelo/Hengelo, the Netherlands
| | - J M Mommers
- Department of Dermatology, St Anna Ziekenhuis, Geldrop, the Netherlands
| | - M I A Koetsier
- Department of Dermatology, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - M A M Berends
- Department of Dermatology, Slingeland Ziekenhuis, Doetinchem, the Netherlands
| | - W P Arnold
- Department of Dermatology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | - B Peters
- Department of Dermatology, Ziekenhuis Rijnstate, Arnhem, the Netherlands
| | - M P M Andriessen
- Department of Dermatology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - C W Den Hengst
- Department of Dermatology, St Antonius Ziekenhuis, Woerden, the Netherlands
| | - A L A Kuijpers
- Department of Dermatology, Máxima Medisch Centrum, Eindhoven, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
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25
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Mourad A, Straube S, Armijo‐Olivo S, Gniadecki R. Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis. Br J Dermatol 2019; 181:450-458. [DOI: 10.1111/bjd.17738] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Affiliation(s)
- A. Mourad
- Faculty of Medicine & Dentistry University of Alberta Medical School Edmonton ABCanada
| | - S. Straube
- Division of Preventive Medicine University of Alberta Edmonton ABCanada
| | - S. Armijo‐Olivo
- Research Center Faculty of Rehabilitation Medicine University of Alberta Edmonton ABCanada
| | - R. Gniadecki
- Division of Dermatology Department of Medicine University of Alberta Edmonton AB Canada
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26
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Sanz-Gil R, Pellicer A, Montesinos MC, Valcuende-Cavero F. Improved effectiveness from individualized dosing of self-administered biologics for the treatment of moderate-to-severe psoriasis: a 5-year retrospective chart review from a Spanish University Hospital. J DERMATOL TREAT 2019; 31:370-377. [PMID: 30924390 DOI: 10.1080/09546634.2019.1602246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Biologics for moderate-to-severe psoriasis are expensive and treatment substitutions may vastly increase cost. Moreover, administration regimens in routine practice may differ from recommended guidelines.Objectives: To evaluate long-term effectiveness, regimen, drug-survival, and efficiency of self-administered biologics in clinical practice.Methods: We performed a 5-year retrospective study in 72 patients (44 ± 14 years old) with moderate-to-severe psoriasis at the University Hospital La Plana (Vila-real, Spain), treated with subcutaneous biologics. We determined the effectiveness (PASI 75 or PASI < 5), and drug-survival using Kaplan-Meier estimates, and analyzed reasons for treatment interruption, drug substitution patterns, and costs.Results: Etanercept was less effective (45%) than ustekinumab (85%) and adalimumab (71%). In 15% of patients, optimal responses were maintained despite dose intervals lengthening. Drug-survival was significantly lower for etanercept than for the other biologics (p < .005). Most adalimumab and etanercept discontinuations were due to adverse events or lack of effectiveness; for ustekinumab the causes were unrelated to drug effects. Ustekinumab was 100% effective as a secondary biologic.Conclusion: Ustekinumab was the safest and most efficient treatment. Etanercept showed the highest treatment failure rate, incurring higher costs. Dosage individualization according to patient needs improves the therapy efficiency, reducing therapeutic failure and derived costs.
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Affiliation(s)
- Roser Sanz-Gil
- Department of Pharmacology, Faculty of Pharmacy, Universitat de València, Valencia, Spain
| | - Antonio Pellicer
- Department of Pharmacy, University Hospital La Plana, Castellón, Spain
| | - M Carmen Montesinos
- Department of Pharmacology, Faculty of Pharmacy, Universitat de València, Valencia, Spain.,Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Valencia, Spain
| | - Francisca Valcuende-Cavero
- Department of Dermatology, University Hospital La Plana, Castellón, Spain.,Pre-departmental Unit of Medicine, Universitat Jaume I, Castellón, Spain
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27
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Lunder T, Zorko MS, Kolar NK, Suhodolcan AB, Marovt M, Leskovec NK, Marko PB. Drug survival of biological therapy is showing class effect: updated results from Slovenian National Registry of psoriasis. Int J Dermatol 2019; 58:631-641. [DOI: 10.1111/ijd.14429] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/16/2019] [Accepted: 02/18/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Tomaz Lunder
- Department of Dermatovenereology University Medical Centre Ljubljana Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
| | - Mateja S. Zorko
- Department of Dermatovenereology University Medical Centre Ljubljana Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
| | - Natasa K. Kolar
- Department of Dermatovenereology Celje General Hospital Celje Slovenia
| | - Aleksandra B. Suhodolcan
- Department of Dermatovenereology University Medical Centre Ljubljana Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
| | - Maruska Marovt
- Department of Dermatovenereology University Medical Centre Maribor MariborSlovenia
| | - Nada K. Leskovec
- Medical Faculty University of Ljubljana Ljubljana Slovenia
- Remeda, Medical Centre Domzale Slovenia
| | - Pij B. Marko
- Department of Dermatovenereology University Medical Centre Maribor MariborSlovenia
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28
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 476] [Impact Index Per Article: 95.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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29
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Sawyer LM, Cornic L, Levin LÅ, Gibbons C, Møller AH, Jemec GB. Long-term efficacy of novel therapies in moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis of PASI response. J Eur Acad Dermatol Venereol 2018; 33:355-366. [PMID: 30289198 PMCID: PMC6587780 DOI: 10.1111/jdv.15277] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/03/2018] [Indexed: 01/15/2023]
Abstract
Background Patients with moderate‐to‐severe psoriasis require long‐term treatment, yet few trials compare outcomes beyond a short‐term induction period. Quantitative comparisons of long‐term outcomes in patients with psoriasis are limited. To our knowledge, no network meta‐analysis (NMA) of such data has been performed. Objective To compare novel systemic therapies, both biologic and non‐biologic, approved for moderate‐to‐severe psoriasis by conducting a systematic review (SR) and NMA of Psoriasis Area and Severity Index (PASI) outcomes measured at or around 1 year. Methods An SR was conducted to identify studies reporting PASI 75, PASI 90 and PASI 100 responses. Feasibility of an NMA on maintenance phase endpoints was assessed and sources of heterogeneity considered. Data appropriate for analysis were modelled using a Bayesian multinomial likelihood model with probit link. Wherever possible, data corresponding to an intention‐to‐treat approach with non‐responder imputation were used. Results Twenty‐four studies reporting outcomes at 40–64 weeks were identified, but heterogeneity in study design allowed synthesis of only 17. Four 52‐week randomized controlled trials (RCTs) comprised the primary analysis, which found brodalumab was significantly more efficacious than secukinumab, ustekinumab and etanercept. Secukinumab was also more efficacious than ustekinumab and both outperformed etanercept. In a secondary analysis, evidence from 13 additional studies and 4 further therapies (adalimumab, apremilast, infliximab and ixekizumab) was included by comparing long‐term outcomes from active interventions to placebo outcomes extrapolated from induction. Results were consistent with the primary analysis: brodalumab was most effective, followed by ixekizumab and secukinumab, then ustekinumab, infliximab and adalimumab. Etanercept and apremilast had the lowest expected long‐term efficacy. Results were similar when studies with low prior exposure to biological therapies were excluded. Conclusion Results suggest that brodalumab is associated with a higher likelihood of sustained PASI response, including complete clearance, at week 52 than comparators. Further long‐term active‐comparator RCT data are required to better assess relative efficacy across therapies.
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Affiliation(s)
| | | | - L Å Levin
- Institute of Health and Medicine, University of Linköping, Linköping, Sweden
| | | | | | - G B Jemec
- Department of Dermatology, Sjaellands Universitetshospital, Roskilde, Denmark
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30
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Lin PT, Wang SH, Chi CC. Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence. Sci Rep 2018; 8:16068. [PMID: 30375427 PMCID: PMC6207685 DOI: 10.1038/s41598-018-34293-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
Drug survival of biologics represents their real-world effectiveness and safety. We conducted a meta-analysis of real-world evidence on the drug survival of biologics in treating psoriasis. We searched the PubMed, CENTRAL, and EMBASE databases from inception to 7th October 2017 for studies reporting the annual drug survival for at least 1 year. Two authors independently screened and selected relevant studies, and assessed their risk of bias. A third author was available for arbitrating discrepancies. We conducted a random-effects model meta-analysis to obtain the respective pooled drug survival from year 1 to 4. We conducted subgroup analysis on biologic-naïve subjects, discontinuation for loss of efficacy and adverse effects. We included 37 studies with 32,631 subjects. The drug survival for all biologics decreased with time, dropping from 66% at year 1 to 41% at year 4 for etanercept, from 69% to 47% for adalimumab, from 61% to 42% for infliximab, and from 82% to 56% for ustekinumab. Ustekinumab was associated with the highest drug survival in all and biologic-naïve subjects. Etanercept was associated with the lowest drug survival and was most commonly discontinued for loss of efficacy. Infliximab was most frequently associated with discontinuation for adverse effects. Clinicians may use this study as a reference in treating psoriasis.
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Affiliation(s)
- Pei-Tzu Lin
- Department of Pharmacy, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Shu-Hui Wang
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Graduate Institute of Applied Science and Engineering, College of Science and Engineering, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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31
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Sbidian E, Mezzarobba M, Weill A, Coste J, Rudant J. Persistence of treatment with biologics for patients with psoriasis: a real‐world analysis of 16 545 biologic‐naïve patients from the French National Health Insurance database (SNIIRAM). Br J Dermatol 2018; 180:86-93. [DOI: 10.1111/bjd.16809] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 01/04/2023]
Affiliation(s)
- E. Sbidian
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
- AP‐HP Hôpitaux universitaires Henri Mondor Département de Dermatologie UPEC 51, av du Maréchal de Lattre de Tassigny Créteil F‐94010 France
- INSERM Centre d'Investigation Clinique 1430 Créteil F‐94010 France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil F‐94010 France
| | - M. Mezzarobba
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - A. Weill
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Coste
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Rudant
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
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32
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Shalom G, Zisman D, Babaev M, Horev A, Tiosano S, Schonmann Y, Comaneshter D, Cohen AD. Psoriasis in Israel: demographic, epidemiology, and healthcare services utilization. Int J Dermatol 2018; 57:1068-1074. [PMID: 29978903 DOI: 10.1111/ijd.14130] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 05/03/2018] [Accepted: 06/13/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Updated data regarding the epidemiology of psoriasis and related healthcare utilization are lacking. OBJECTIVE To investigate the epidemiology, comorbidities, healthcare services utilization, and drug use in a large group of patients with psoriasis from Clalit Health Services (CHS) database. METHODS A controlled cross-sectional study was performed. Case patients were defined when there was at least one documented diagnosis of psoriasis registered by a CHS dermatologist between the years 1998-2016. The extracted data included metabolic, cardiovascular and psychiatric comorbidities; community clinic visits; in- and outpatient services utilization profiles and drug use data, which included pharmacy claims of topical and systemic treatments, including phototherapy and climatotherapy. Comparative analysis was performed by a univariate and multivariate analysis, adjusting for age, gender, obesity, and smoking. RESULTS The study included 118,680 patients with psoriasis (prevalence of 2.69%) and 118,680 age- and gender-matched controls. Patients with psoriasis had increased prevalence of metabolic, cardiovascular, and psychiatric illnesses. Psoriasis was significantly associated with an increased healthcare utilization. The mean (SD) number of annual dermatologist clinic visits and emergency room visits was 7.2 ± 12.4 and 2.9 ± 7.7 in psoriasis patients as compared to 2.9 ± 7.9 and 2.7 ± 7.4 in the control group (P < 0.001). Topical steroids were the most applied treatment in psoriasis patients (15.5%), and topical vitamin D analogs were second in use (14.6%). Traditional systemic treatment for psoriasis was used in 3.8% of the patients, and biologic treatments were used in 1.6% of the patients. CONCLUSIONS Our study quantifies healthcare services utilization and drug use in patients with psoriasis.
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Affiliation(s)
- Guy Shalom
- Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel.,Division of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa, Haifa, Israel
| | - Meir Babaev
- Department of Dermatology and Venereology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Horev
- Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel.,Division of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shmuel Tiosano
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel
| | - Yochai Schonmann
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Department of Family Medicine, Rabin Medical Center, Clalit Health Services, Tel Aviv, Israel
| | - Doron Comaneshter
- Chief Physician's Office, Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2018; 80:251-265.e19. [PMID: 29928910 DOI: 10.1016/j.jaad.2018.06.027] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide-ranging prevalence estimates of psoriatic arthritis (PsA) in patients with psoriasis have been reported. OBJECTIVES To assess the prevalence and incidence of PsA in patients with psoriasis. METHODS Two authors independently searched 3 databases for studies reporting on the prevalence or incidence of PsA in patients with psoriasis. A proportion meta-analysis was performed to calculate the pooled proportion estimates of PsA in patients with psoriasis. RESULTS A total of 266 studies examining 976,408 patients with psoriasis were included. Overall, the pooled proportion (95% confidence interval [CI]) of PsA among patients with psoriasis was 19.7% (95% CI, 18.5%-20.9%). In children and adolescents (<18 years of age), the pooled prevalence was 3.3% (95% CI, 2.1%-4.9%). The PsA prevalence was 22.7% (95% CI, 20.6%-25.0%) in European patients with psoriasis, 21.5% (95% CI, 15.4%-28.2%) in South American patients with psoriasis, 19.5% (95% CI, 17.1%-22.1%) in North American patients with psoriasis, 15.5% (95% CI, 0.009%-51.5%) in African patients with psoriasis, and 14.0% (95% CI, 95% CI, 11.7%-16.3%) in Asian patients with psoriasis. The prevalence of PsA was 23.8% (95% CI, 20.1%-27.6%) in studies in which the Classification Criteria for Psoriatic Arthritis were applied. The incidence of PsA among patients with psoriasis ranged from 0.27 to 2.7 per 100 person-years. LIMITATIONS Between-study heterogeneity may have affected the estimates. CONCLUSIONS We found that 1 in 4 patients with psoriasis have PsA. With the growing recognition of the Classification Criteria for Psoriatic Arthritis, more homogenous and comparable prevalence estimates are expected to be reported.
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Polivka L, Oubaya N, Bachelez H, Paul C, Richard MA, Beylot-Barry M, Schmutz JL, Beneton N, Mahé E, Viguier M, Chosidow O, Canoui-Poitrine F, Sbidian E. Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015. J Eur Acad Dermatol Venereol 2018; 32:1920-1929. [PMID: 29729123 DOI: 10.1111/jdv.15044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the late 2000s, the introduction of biologics transformed the prognosis for patients with moderate-to-severe psoriasis. We hypothesized that treatment with biologics may associate with a reduction in the hospitalization rate for psoriasis flares. OBJECTIVE To analyse changes over time in the hospitalization rate for psoriasis flares. METHODS We included inpatient stays in any of nine French hospitals between 2005 and 2015 for a psoriasis flare, as documented in the national inpatient database. In two centres, we also analysed data from the individual patients' electronic medical records. RESULTS A total of 3572 stays were included. The introduction of biologics was not associated with a decrease in the number of hospitalizations for a psoriasis flare; on the contrary, we observed a non-significant increase in the number of hospitalizations (13 hospitalizations for psoriasis flares per quarter per 10 000 beds). In the two-centre study, the introduction of biologics was associated with a significant increase in the hospitalization of patients receiving topical treatments only (520 hospitalizations per year per 10 000 beds) and those with a first psoriasis flare. CONCLUSION The number of hospitalizations for a psoriasis flare tended to increase between 2005 and 2015. The availability of additional treatment options might have increased patient demand and/or broadened the indications in clinical practice.
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Affiliation(s)
- L Polivka
- Department of Dermatology, Necker-Enfants Malades Hospital (AP-HP), Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - N Oubaya
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - H Bachelez
- Department of Dermatology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France
| | - C Paul
- Department of Dermatology, Larrey Hospital, Toulouse University, Toulouse, France
| | - M A Richard
- Dermatology Department, Centre de recherche en oncologie biologique et oncophamacologie', UMR 911, INSERM CRO2, Timone Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - M Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - J L Schmutz
- Department of Dermato-Allergology, Brabois Hospital, Nancy University, Vandoeuvre-lès-Nancy, France
| | - N Beneton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - E Mahé
- Department of Dermatology, Victor Dupouy Hospital, Argenteuil, France
| | - M Viguier
- Department of Dermatology, Robert Debré Hospital, University of Reims-Champagne Ardennes, Reims, France
| | - O Chosidow
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
| | - F Canoui-Poitrine
- Department of Clinical Research and Public Health, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), UPEC, DHU A-TVB, Paris-Est University, Créteil, France
| | - E Sbidian
- Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France.,UPEC, DHU VIC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Paris-Est University, Créteil, France
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Costanzo A, Malara G, Pelucchi C, Fatiga F, Barbera G, Franchi A, Galeone C. Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival. Dermatology 2018; 234:1-12. [DOI: 10.1159/000488586] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/17/2018] [Indexed: 12/26/2022] Open
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Sherman S, Hodak E, Pavlovsky L. Can etanercept treatment failure in moderate-to-severe psoriasis be overcome by addition of low-dose methotrexate? A single-center experience. J DERMATOL TREAT 2018; 29:666-670. [PMID: 29466892 DOI: 10.1080/09546634.2018.1441491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Loss of efficacy is a major anticipated shortcoming of utilizing etanercept and other biologic agents for treating moderate-to-severe psoriasis. PURPOSE To investigate the addition of low-dose methotrexate as a means to increase etanercept drug survival. METHODS Eleven patients with severe psoriasis were switched to a combination of etanercept with low-dose methotrexate therapy, after a primary or secondary failure with etanercept treatment as a monotherapy. Time period for cessation of combined treatment and side effects were documented. The effect of previous methotrexate treatment was investigated. RESULTS Six men and five women were included in the study. The patients had moderate-to-severe psoriasis with a mean baseline Psoriasis Area and Severity Index (PASI) of 29 (median 25). Median duration of etanercept monotherapy was 12 months. Median duration of combined treatment was 13 months. Combined treatment was discontinued in three patients due to side effects. Previous failure of methotrexate monotherapy did not alter the duration of the combined treatment. CONCLUSION Addition of low-dose methotrexate may rescue etanercept therapy after failure of etanercept monotherapy in patients with moderate-to-severe psoriasis.
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Affiliation(s)
- Shany Sherman
- a Department of Dermatology , Rabin Medical Center-Beilinson Hospital , Petach Tikva , Israel
| | - Emmilia Hodak
- a Department of Dermatology , Rabin Medical Center-Beilinson Hospital , Petach Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Lev Pavlovsky
- a Department of Dermatology , Rabin Medical Center-Beilinson Hospital , Petach Tikva , Israel
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Choi CW, Choi JY, Kim BR, Youn SW. Economic Burden Can Be the Major Determining Factor Resulting in Short-Term Intermittent and Repetitive Ustekinumab Treatment for Moderate-to-Severe Psoriasis. Ann Dermatol 2018; 30:179-185. [PMID: 29606815 PMCID: PMC5839889 DOI: 10.5021/ad.2018.30.2.179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/11/2022] Open
Abstract
Background The continuous use of biologic agents in the treatment of psoriasis has been reported to result in successful and sustained therapeutic effects and safety. However, some patients choose intermittent and repetitive treatment. Objective To determine the factors for selecting intermittent and repetitive ustekinumab treatment for the management of psoriasis. Methods From January 2011 to October 2016, we enrolled 30 psoriasis patients who discontinued ustekinumab treatment and were followed up for psoriasis treatment. We reviewed data regarding patients' clinical characteristics and the treatment they received, and investigated the factors for selecting intermittent treatment. Results A total of 52 ustekinumab treatment periods were administered to the 30 patients. Of the 52 treatment periods, 34.6% were covered by insurance and 82.4% were discontinued after sufficient improvement had been made or at the patient's request. Further analysis comparing the first and second ustekinumab treatments revealed that the patients who used ustekinumab in second treatment were more likely to be insured. In addition, the rate of patients reaching psoriasis area and severity index (PASI)75 and PASI90 was similar between the first and subsequent ustekinumab treatments. Conclusion We found that the patients who used ustekinumab intermittently were those who were satisfied with the outcome of ustekinumab treatment but could not afford the treatment. These results suggested that economic burden can be a factor for the patients' choice of short-term intermittent treatment. The expansion of insurance coverage can increase the effectiveness of, and patients' satisfaction with, the management of psoriasis.
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Affiliation(s)
- Chong Won Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Young Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Abstract
INTRODUCTION Psoriasis has a profound impact on patients' lives, but adherence to topical treatment of psoriasis is still poor. Biologic treatment has revolutionized the management of psoriasis, but adherence to treatment may still be a barrier for some patients. Areas covered: A PubMed search was conducted in August 2017 using the terms 'biologics psoriasis adherence' and 'biologics psoriasis survival.' Additional articles were obtained by perusing the references of articles identified in the original PubMed search. Articles that did not specifically mention 'survival,' 'adherence,' or 'persistence' were not included. We review the measures used to assess adherence to biologics for psoriasis and the factors impacting drug survival and adherence rates for biologics in psoriasis. Expert commentary: Drug survival and adherence rates for biologic therapy is less than ideal but may be modifiable. Means that may improve adherence and drug survival include individualized choice of biologic and providing additional support for patients who are at increased risk for prematurely stopping treatment.
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Affiliation(s)
- Lauren Seale
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Leah A Cardwell
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA
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Choi CW, Yang S, Jo G, Kim BR, Youn SW. Economic Factors as Major Determinants of Ustekinumab Drug Survival of Patients with Chronic Plaque Psoriasis in Korea. Ann Dermatol 2018; 30:668-675. [PMID: 33911506 PMCID: PMC7992448 DOI: 10.5021/ad.2018.30.6.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Drug survival, defined as the time until discontinuation, is a parameter reflecting real-world therapeutic effectiveness. Few studies have examined the influence of economic factors on the drug survival of biologic agents for psoriasis, particularly in Asian countries. Objective To determine the drug survival for ustekinumab in real-life settings and investigate the factors affecting drug survival for psoriasis patients in Korea. Methods We evaluated 98 psoriasis patients who were treated with ustekinumab at a single center. We analyzed the efficacy and drug survival of ustekinumab. Cox proportional hazard analysis and competing risk regression analysis were performed to reveal the factors affecting the drug survival of ustekinumab. Results The overall mean drug survival was 1,596 days (95% confidence interval [CI], 904~2,288). Among the 39 cessations of ustekinumab treatment, 9 (23.1%) patients discontinued treatment after experiencing satisfactory results. Multivariate Cox proportional hazard analysis revealed that paying on patients' own expense was the major predictor for the discontinuation of ustekinumab (hazard ratio [HR], 9.696; 95% CI, 4.088~22.998). Competing risk regression analysis modeling of discontinuation because of factors other than satisfaction of an event also revealed that ustekinumab treatment at the patient's expense (HR, 4.138; 95% CI, 1.684~10.168) was a predictor of discontinuation rather than satisfaction. Conclusion The results of our study revealed that the cost of biologics treatment affects the drug survival of ustekinumab and suggested that economic factors affect the drug survival of ustekinumab treatment in Korea.
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Affiliation(s)
- Chong Won Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungkeol Yang
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwanghyun Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Affiliation(s)
| | - Robert A Colbert
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD
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