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Martos-Cabrera L, Llamas-Velasco M, Armesto S, Herrera-Acosta E, Vidal D, Vilarrasa E, Rivera-Diaz R, de la Cueva P, Martorell-Calatayud A, Ballescá F, Belinchón I, Carretero G, Rodríguez L, Romero-Maté A, Pujol-Montcusí J, Salgado-Boquete L, Sahuquillo-Torralba A, Coto-Segura P, Baniandrés O, Feltes R, Alsina M, Daudén E. High adherence to secukinumab in patients with moderate to severe psoriasis: a long-term multicenter study in a daily practice setting. Int J Dermatol 2023; 62:e146-e149. [PMID: 35867958 DOI: 10.1111/ijd.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Susana Armesto
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David Vidal
- Hospital de Sant Joan Despí Moisés Broggi, Barcelona, Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Ferran Ballescá
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Isabel Belinchón
- Hospital General Universitario de Alicante - ISABIAL, Alicante, Spain
| | | | | | | | | | | | | | | | | | - R Feltes
- Hospital Universitario la Paz, Madrid, Spain
| | - M Alsina
- Hospital Clínic i Provincial, Barcelona, Spain
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Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients-A BioCAPTURE Registry Study. Drugs Aging 2022; 39:715-727. [PMID: 35859228 PMCID: PMC9300332 DOI: 10.1007/s40266-022-00961-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Psoriasis is a common inflammatory disease in any age group, but also in older patients (≥ 65 years of age). Since older patients are often excluded from clinical trials, limited data specifically on this growing population are available, e.g. regarding the safety and performance of biological treatment. AIMS We aimed to give insight into this specific population by comparing the drug survival and safety of biologics in older patients with that in younger patients. METHODS In this real-world observational study, data from 3 academic and 15 non-academic centers in The Netherlands were extracted from the prospective BioCAPTURE registry. Biologics included in this study were tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-12/23, and IL-23 inhibitors. Patients were divided into two age groups: ≥ 65 years and < 65 years. The Charlson Comorbidity Index (CCI) was used to measure comorbid disease status, and all adverse events (AEs) that led to treatment discontinuation were classified according to the Medical Dictionary for Regulatory Activities (MedDRA) classification. All AEs that led to treatment discontinuation were studied to check whether they could be classified as serious AEs (SAEs). Kaplan-Meier survival curves for overall 5-year drug survival and split according to reasons of discontinuation (ineffectiveness or AEs) were constructed. Cox regression models were used to correct for possible confounders and to investigate associations with drug survival in both age groups separately. Psoriasis Area and Severity Index (PASI) scores during the first 2 years of treatment and at the time of treatment discontinuation were assessed and compared between age groups. RESULTS A total of 890 patients were included, of whom 102 (11.4%) were aged ≥ 65 years. Body mass index, sex, and distribution of biologic classes (e.g. TNFα, IL12/23) were not significantly different between the two age groups. A significantly higher CCI score was found in older patients, indicative of more comorbidity (p < 0.001). The 5-year ineffectiveness-related drug survival was lower for older patients (44.5% vs. 60.5%; p = 0.006), and the 5-year overall (≥ 65 years: 32.4% vs. < 65 years: 42.1%; p = 0.144) and AE-related (≥ 65 years: 82.1% vs. < 65 years: 79.5%; p = 0.913) drug survival was comparable between age groups. Of all AEs (n = 155) that led to discontinuation, 16 (10.3%) were reported as SAEs but these only occurred in younger patients. After correcting for confounders, the same trends were observed in the drug survival outcomes. Linear regression analyses on PASI scores showed no statistical differences at 6, 12, 18, and 24 months of treatment between age groups. CONCLUSIONS This study in a substantial, well-defined, prospective cohort provides further support that the use of biologics in older patients seems well-tolerated and effective. Biologic discontinuation due to AEs did not occur more frequently in older patients. Older patients discontinued biologic treatment more often due to ineffectiveness, although no clear difference in PASI scores was observed. More real-world studies on physician- and patient-related factors in older patients are warranted.
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Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol 2019; 33:2253-2263. [PMID: 31454113 DOI: 10.1111/jdv.15913] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022]
Abstract
Adherence describes how a patient follows a medical regime recommended by a healthcare provider. Poor treatment adherence represents a complex and challenging problem of international healthcare systems, as it has a substantial impact on clinical outcomes and patient safety and constitutes an important financial burden. Since it is one of the most common causes of treatment failure, it is extremely important for physicians to reliably distinguish between non-adherence and non-response. This systematic review aims to summarize the current literature on treatment adherence in dermatology, focusing on chronic inflammatory skin diseases such as psoriasis, atopic dermatitis and acne. A systematic literature search was performed using the PubMed Database, including articles from 2008 to 2018. Low treatment adherence is a multidimensional phenomenon defined by the interplay of numerous factors and should under no circumstances be considered as the patient's fault alone. Factors influencing treatment adherence in dermatology include patient characteristics and beliefs, treatment efficacy and duration, administration routes, disease chronicity and the disease itself. Moreover, the quality of the physician-patient relationship including physician-time available for the patient plays an important role. Understanding patients' adherence patterns and the main drivers of non-adherence creates opportunities to improve adherence in the future. Strategies to increase treatment adherence range from reminder programs to simplifying prescriptions or educational interventions. Absolute adherence to treatment may not be realistically achievable, but efforts need to be made to raise awareness in order to maximize adherence as far as possible.
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Affiliation(s)
- L Eicher
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - M Knop
- Derma I, München Klinik, Munich, Germany
| | - N Aszodi
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - S Senner
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany
| | - L E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.,Derma I, München Klinik, Munich, Germany
| | - A Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.,Derma I, München Klinik, Munich, Germany
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da Silva N, von Stülpnagel C, Langenbruch A, Danckworth A, Augustin M, Sommer R. Disease burden and patient needs and benefits in anogenital psoriasis: developmental specificities for person-centred healthcare of emerging adults and adults. J Eur Acad Dermatol Venereol 2019; 34:1010-1018. [PMID: 31715033 DOI: 10.1111/jdv.16076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Establishing romantic relationships involving cohabitation and/or sexual intercourse is an overriding task for many people during emerging adulthood, i.e. from their late teens through the twenties. The diagnosis of anogenital psoriasis may hinder social/intimate relationships, resulting in higher disease burden in this age group. OBJECTIVES To compare the disease burden and patient needs/benefits between emerging adults (18-30 years) and adults (>30 years) with psoriasis, with and without anogenital involvement; and to identify sociodemographic/clinical variables accounting for better patient-reported outcomes. METHODS Patients aged ≥18 years with psoriasis vulgaris were recruited within a cross-sectional nationwide survey randomly assigning 157 dermatology practices/clinics in Germany. Anogenital involvement was established based on a high-resolution grid on the topology of psoriasis. The main outcome measures were the Psoriasis Area and Severity Index (PASI), the EuroQoL visual analogue scale (EQ-VAS), the Dermatology Life Quality Index (DLQI) and the Patient Benefit Index (PBI). RESULTS Participants were 1921 patients: 173 emerging adults and 1749 adults >30 years. Anogenital involvement was observed in 621 patients (32.3%). Patient with anogenital psoriasis reported decreased health and more QoL impairments compared with those without anogenital lesions. Emerging adults presented more QoL impairments and less treatment benefits than older patients, and they were more prone to underrate a wide range of needs, except when the anogenital area was affected. Beyond anogenital involvement and higher disease severity, less treatment benefits were associated with more QoL impairments, particularly for emerging adults. CONCLUSIONS The developmental instability of many emerging adults may result in difficulties to establish/adhere to treatment goals and thus in decreased perception of treatment benefit and more QoL impairments. Anogenital involvement is a risk factor for increased disease burden regardless of age. Assessing anogenital involvement in all patients and helping younger patients to define/adhere to treatment goals should be prioritized in patient-centred healthcare for psoriasis.
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Affiliation(s)
- N da Silva
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C von Stülpnagel
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Langenbruch
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Danckworth
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Aleshaki JS, Cardwell LA, Muse ME, Feldman SR. Adherence and resource use among psoriasis patients treated with biologics. Expert Rev Pharmacoecon Outcomes Res 2018; 18:609-617. [DOI: 10.1080/14737167.2018.1512408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Joseph S. Aleshaki
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah A. Cardwell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mikél E. Muse
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Alpalhão M, Antunes J, Gouveia A, Travassos R, Lopes L, Sanches M, Pinto A, Rodrigues B, Calado S, Ferreira J, Filipe P. A randomized controlled clinical trial to assess the impact of motivational phone calls on therapeutic adherence in patients suffering from psoriasis. Dermatol Ther 2018; 31:e12667. [DOI: 10.1111/dth.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Miguel Alpalhão
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
| | - Joana Antunes
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Ana Gouveia
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Rita Travassos
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Leonor Lopes
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Maria Sanches
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Ana Pinto
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Bruno Rodrigues
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - Susana Calado
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
| | - João Ferreira
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
| | - Paulo Filipe
- Dermatology Department; Hospital de Santa Maria; Lisbon Portugal
- Dermatology Research Unit; Instituto de Medicina Molecular; Lisbon Portugal
- Dermatology Clinical Department; Faculty of Medicine of the University of Lisbon; Lisbon Portugal
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