1
|
Mastorino L, Richiardi I, Gelato F, Cavaliere G, Quaglino P, Ortoncelli M, Ribero S. Predisposition to conjunctivitis and male sex reduces drug survival of dupilumab in adults and adolescents. Expert Opin Biol Ther 2024:1-6. [PMID: 38913354 DOI: 10.1080/14712598.2024.2372367] [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: 04/05/2024] [Accepted: 06/21/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND There are currently limited data on dupilumab drug survival (DS), especially on factors possibly associated with drug discontinuation. MATERIALS AND METHODS The primary endpoint of this study is to evaluate the parameters that may determine drug discontinuation and the predictive factors associated with dupilumab DS. We considered as independent associated factors: childhood onset of disease, gender, age of onset of AD, age of initiation of dupilumab, previous use of cyclosporine, initial mean EASI, atopic family history, and predisposition to allergic conjunctivitis. RESULTS On 413 patients DS was 94.5% at 1 year, 89.5% at 2 years, and 83.7% at 3 years, and after a mean follow-up of 40.5 months (±1.6) 53 patients had discontinued the drug permanently (12.8%). Univariate analysis showed that the only factor associated with a reduction in drug survival was a predisposition to allergic conjunctivitis (p 0.009). At multivariate Cox regression, male sex (HR, 2.34; 95% CI, 1.14-4.78; p 0.02) and predisposition to allergic conjunctivitis (HR, 2.61; 95% CI, 1.37-5.00; p 0.004) were associated with lower DS of dupilumab. CONCLUSION Male gender and predisposition to allergic conjunctivitis are negative predictors for maintenance of response to treatment with dupilumab and consequently associated with lower DS rates.
Collapse
Affiliation(s)
- Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Irene Richiardi
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Federica Gelato
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Giovanni Cavaliere
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Michela Ortoncelli
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Ting S, Lowe P, Smith A, Fernández-Peñas P. Drug survival of biologics in psoriasis: An Australian multicentre retrospective study. Australas J Dermatol 2024; 65:350-357. [PMID: 38509804 DOI: 10.1111/ajd.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Drug survival, which refers to the time from treatment initiation to discontinuation, provides a surrogate measure of the effectiveness of a biologic in a real-world setting (J Invest Dermatol, 2015, 135, 1). The aim of this study was to determine the drug survival of biologics that are currently available in Australia. We also analysed the treatment efficacy of these biologics and reasons for discontinuation. METHODS Retrospective data from outpatient Dermatology biologic clinics in Westmead Hospital and Royal Prince Alfred Hospital (Sydney, Australia) from April 2006 to December 2020 were collected. Kaplan-Meier analysis was used to calculate drug survival. RESULTS A total of 306 patients who underwent 566 treatment courses were analysed. Guselkumab was observed to have the longest drug survival, with cumulative drug survival rates of 94.2% ± 4.0 at 1- and 5-years. This was followed by ixekizumab which had a 1-year survival rate of 87.2% ± 4.5 and 5-year survival rate of 59.4% ± 9.5. Ixekizumab and guselkumab were also noted to have superior treatment efficacy compared with other biologics, with PASI-75 rates of 94.9% and 93.8%, respectively. The most common reasons for treatment discontinuation were a lack of initial efficacy to treatment and a loss of efficacy over time despite an initial response, respectively. CONCLUSION To our knowledge, this is the first Australian study to report on outcomes of multiple new biologics that are currently in use for the treatment of chronic plaque psoriasis. Overall, this study provides insight into patterns of care from a local experience that may help guide the management of moderate-to-severe psoriasis.
Collapse
Affiliation(s)
- Samantha Ting
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Patricia Lowe
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Annika Smith
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Pablo Fernández-Peñas
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Wilsmann-Theis D, Funk R, Mössner R, Bieber T, Wenzel J. Efficacy and Safety of Methotrexate in Psoriasis Vulgaris Long-Term Treatment: A Real-World Observation Study. Indian J Dermatol 2023; 68:669-673. [PMID: 38371546 PMCID: PMC10869019 DOI: 10.4103/ijd.ijd_551_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Methotrexate (MTX) in the therapy of psoriasis vulgaris (PV) is a well and long-established treatment option. Aims To assess the long-term experience of individual patients in the real world with regard to the efficacy and safety of MTX in PV therapy. Patients and Methods In a retrospective study, MTX as a weekly used monotherapy in PV was examined. Clinical data including the Psoriasis Area Severity Index (PASI), prevalence of psoriatic-arthritis (PsA), Investigator Global Assessment (IGA), laboratory parameters, occurrence of adverse events (AEs), dosing of MTX and characteristics of patients treated for at least 24 months were collected. Results A total of 55 patients with 247 patient-years under MTX therapy were included. The mean PASI reduction was 51.2% with a significant (P < 0.001) improvement in the skin condition in the first 6 months of treatment, remaining stable thereafter. The mean MTX dose increased from 11.8 ± 3.7 mg to 12.9 ± 3.8 mg in the first year of therapy, with a constant mean dose in the following years. In 247 patient-years, no serious AE was documented. Gastrointestinal side effects or fatigue were commonly detected. The liver parameter alanine aminotransferase/ glutamate-pyruvate transaminase (ALT/GPT) (baseline 35.8 ± 22.0 U/L) increased after 3 years of therapy (42.0 ± 22.4 U/L; P = 0.013) without clinical significance. Conclusion In this patient collective, MTX in low doses was effective and safe in long-term therapy. The improved skin condition was steady and reached by an unvarying dose. New data showed a better efficacy of MTX in higher doses; however, additional data must be collected on the long-term efficacy and safety of MTX with a higher dose regime.
Collapse
Affiliation(s)
| | - Rhena Funk
- From the Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - Rotraut Mössner
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Bieber
- From the Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - Jörg Wenzel
- From the Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| |
Collapse
|
4
|
Burlando M, Campione E, Cuccia A, Malara G, Naldi L, Prignano F, Zichichi L. Real-world use of dimehtyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus. Dermatol Reports 2022. [DOI: 10.4081/dr.2023.9613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderate-to-severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. Seven dermatology experts gathered online for three meetings to identify consensus on use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. Twenty statements were discussed and voted on using a facilitator-mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug–drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and slow titration schedule. Hematologic monitoring throughout treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on optimal use of DMF to treat psoriasis.
Collapse
|
5
|
Trajectories of systemic agent use and associated depression- and anxiety-related health care costs among patients with psoriasis. JAAD Int 2022; 9:11-22. [PMID: 35996750 PMCID: PMC9391576 DOI: 10.1016/j.jdin.2022.06.018] [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] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Systemic treatment patterns and related mental health disorders and economic burden among patients with psoriasis are largely unknown. Objective To assess systemic treatment patterns and associated depression and anxiety-related health care costs among patients with psoriasis initiating a conventional systemic treatment (CST). Methods Using a retrospective cohort design with sequence and cluster analyses, we assessed systemic treatment trajectories (CST and tumor necrosis factor inhibitors or ustekinumab, [TNFi/UST]) over a 2-year period following CST initiation. We compared health care costs between trajectories using 2-part models. Results We included 781 patients and identified 8 trajectories: persistent methotrexate users, persistent acitretin users, early CST discontinuation, late methotrexate discontinuation, switch to TNFi/UST, adding TNFi/UST, discontinuation then restart on methotrexate, and discontinuation then restart on acitretin or multiple CST switches. Overall, 165 (21%) patients incurred depression- and anxiety-related health care costs (median annual cost, CAN$56; quartiles, $14-$127). Compared with persistent methotrexate users, adding a TNFi/UST (cost ratio, 3.63; 95% CI, 1.47-5.97) and discontinuation then restart on acitretin or multiple switches between systemic agents (cost ratio, 13.3; 95% CI 5.76-22.47) had higher costs. Limitations Trajectory misclassification may have occured. These date represent an association, and causality cannot be inferred, particularly given the risk of confounding. Conclusion Depression- and anxiety-related health care costs were high among patients adding TNFi/UST and those discontinuing then restarting on acitretin or experiencing multiple switches between systemic agents.
Collapse
|
6
|
Mahé E, Beauchet A, Hadj‐Rabia S, Mazereeuw‐Hautier J, Mallet S, Phan A, Severino‐Freire M, Boralevi F, Aubert H, Barthélémy H, Girard C, Martin L, Piram M, Barbarot S, Balguerie X, Zitouni J, Phan C, Di Lernia V. Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis. Real‐life data from the BiPe cohorts and a practice survey among French and Italian paediatric dermatologists. Dermatol Ther 2022; 35:e15828. [DOI: 10.1111/dth.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Mahé
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Alain Beauchet
- Public Health department, Centre Hospitalier Universitaire Ambroise Paré Boulogne‐Billancourt France
| | - Smaïl Hadj‐Rabia
- Dermatology department INSERM U1163 & Institut Imagine, Centre Hospitalier Universitaire Necker‐Enfants Malades, Assistance Publique‐Hôpitaux de Paris, Université Paris Descartes ‐ Sorbonne, Paris Cité Paris France
| | - Juliette Mazereeuw‐Hautier
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Stéphanie Mallet
- Dermatology department Hôpital de la Timone, Assistance‐publique‐Hôpitaux de Marseille Marseille France
| | - Alice Phan
- Paediatric department Hôpital Femme‐Mère‐Enfant, Hospices Civils de Lyon Bron France
| | - Maëlle Severino‐Freire
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Franck Boralevi
- Department of Paediatric Dermatology Hôpital Pellegrin, CHU de Bordeaux Bordeaux France
| | - Hélène Aubert
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Hugue Barthélémy
- Dermatology department Centre Hospitalier d'Auxerre Auxerre France
| | - Céline Girard
- Dermatology department Centre Hospitalier Universitaire de Montpellier Montpellier France
| | - Ludovic Martin
- Dermatology department Centre Hospitalier Universitaire d'Angers Angers France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Université Paris Sud‐Saclay, UVSQ, Assistance Publique‐Hôpitaux de Paris HP Le Kremlin Bicêtre France
| | - Sébastien Barbarot
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Xavier Balguerie
- Dermatology department Centre Hospitalier Universitaire Charles‐Nicolle Rouen France
| | - Jinane Zitouni
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Céline Phan
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Vito Di Lernia
- Dermatology unit, Arcispedale S. Maria Nuova IRCCS Reggio Emilia Italy
| | | | | | | |
Collapse
|
7
|
Karapetyan S, Davtyan H, Khachikyan K, Hakobyan G. Impact of Supplemental Essential Phospholipids on Treatment Outcome and Quality of Life of Patients With Psoriasis With Moderate Severity. Dermatol Ther 2022; 35:e15335. [PMID: 35088499 DOI: 10.1111/dth.15335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 02/03/2023]
Abstract
Aim of this study was to evaluate effect of supplemental of Essential Phospholipids (EPL) on the treatment efficacy in patients with moderate psoriasis. 132 subjects over 18 years of age with diagnosed psoriasis participated in this study. Patients were randomly assigned 2 treatment groups. 2 types of treatment were used for the treatment of the patients. First group of patients received conventional treatment which included systemic immunosuppresant, antihistamine, calcium gluconate and topical salicylic acid. Second group (n = 67) received same treatment with supplemental Essential Phospholipids (EPL) Data was comprised of age, gender, psoriasis area and severity index (PASI) and dermatological life quality index (DLQI) scores, other clinical/laboratory characrteristics including TNF-α, IL-1α, IL-2, INF-γ, IL-10, TGF-β. All measurements were done before and after treatments. After treatment in the treatment groups the PASI scores decreased to 4.5 (SD ± 2.66) and 2.09 (SD ±1.09) respectively. The observed difference was statistically significant (p < 0.001). Change of PASI score was greater in group II on average by 2.81 (SD ±0.38). After treatment in both groups the DLQI scores decreased to 4.42 (SD ± 1.23) and 3.91 (SD ± 0.34) respectively. The observed difference was statistically significant (p < 0.001). Change of DLQI score was greater in group II on average by 4.29 (SD ±0.44). We can state that addition of Essential Phospholipids to the standard treatment can improve treatment outcomes and quality of life in patients with moderate psoriasis.
Collapse
Affiliation(s)
- Shushanik Karapetyan
- Department of Dermotology, Yerevan State Medical University Named after M. Heratsi, Yerevan, Armenia
| | - Hayk Davtyan
- Research and Prevention Center NGO, Yerevan, Armena, Hayk Davtyan MPHTB, Armenia
| | - Khachik Khachikyan
- Department of Dermotology, Yerevan State Medical University Named after M. Heratsi, Yerevan, Armenia
| | - Gagik Hakobyan
- Department of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Armenia; Gagik Hakobyan DMSc, PhD, Head of Department of Oral and Maxillofacial Surgery
| |
Collapse
|
8
|
Polymorphism in Gene for ABCC2 Transporter Predicts Methotrexate Drug Survival in Patients with Psoriasis. Medicina (B Aires) 2021; 57:medicina57101050. [PMID: 34684087 PMCID: PMC8539794 DOI: 10.3390/medicina57101050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Methotrexate is widely prescribed for the treatment of moderate-to-severe psoriasis. As drug survival encompasses efficacy, safety, and treatment satisfaction, such studies provide insights into successful drug treatments in the real-life scenario. The objective was to define methotrexate drug survival and reasons for discontinuation, along with factors associated with drug survival, in a cohort of adult patients with moderate-to-severe plaque psoriasis. Materials and Methods: Data on methotrexate treatment were extracted from our institutional registry. Drug survival was estimated by Kaplan–Meier analysis, and predictors of drug survival were analyzed by Cox proportional hazards regression. Results: We included 133 patients treated with methotrexate. Due to significant effects of the year of treatment initiation, drug survival analysis was performed for 117 patients who started methotrexate in 2010 or later. Median methotrexate drug survival was 11.0 months. Overall, 89% of patients discontinued treatment, with over half of these (51%) due to lack of efficacy. Significantly longer drug survival was seen for patients who discontinued treatment due to lack of efficacy versus drug safety (p = 0.049); when stratified by sex, this remained significant only for women (p = 0.002). The patient ABCC2 rs717620 genotype was significantly associated with drug survival in both univariate log-rank and multivariate Cox regression analyses, with variant T allele associated with longer drug survival (hazard ratio, 0.606; 95% confidence interval, 0.380–0.967; p = 0.036). Conclusions: We have identified the novel association of patient ABCC2 rs717620 genotype with methotrexate drug survival. This pharmacogenetic marker might thus help in the management of psoriasis patients in daily practice.
Collapse
|
9
|
Distel J, Cazzaniga S, Seyed Jafari SM, Emelianov V, Schlapbach C, Yawalkar N, Heidemeyer K. Long-Term Effectiveness and Drug Survival of Apremilast in Treating Psoriasis: A Real-World Experience. Dermatology 2021; 238:267-275. [PMID: 34091455 DOI: 10.1159/000515763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor used for the treatment of moderate to severe psoriasis. Long-term data on the effectiveness and drug survival of patients treated with apremilast are limited. OBJECTIVE The aim of this study was to analyze the characteristics, effectiveness, and drug survival of patients treated with apremilast in a real-world setting. METHODS We conducted a retrospective cohort study of patients with psoriasis who received at least 1 dose of apremilast between 2015 and 2018. We documented sex; age; type, duration, and severity (using Psoriasis Area Severity Index [PASI] and Dermatology Life Quality Index [DLQI]) of psoriasis; comorbidities; previous treatment modalities; adverse events; and reasons for therapy discontinuation. For drug survival, estimates and efficacy analysis with Kaplan-Meier statistics were used. RESULTS The drug survival rate of the 93 reviewed patients was 69.5% at 6 months, 34.7% at 12 months, and 25.8% at 24 months after initiating therapy. The median survival duration was 8.0 months. Therapy was discontinued in 66.6 and 27.8% due to loss of efficacy and adverse events, respectively. At 24 months, 35.9% had achieved PASI75 response and 23.7% had achieved PASI90 response. Most observed adverse events were gastrointestinal issues, weight loss, and headache. CONCLUSIONS Apremilast is an effective and well-tolerated therapy for patients with moderate to severe psoriasis, especially for patients with difficult-to-treat locations and/or contraindications to other biologics. Furthermore, apremilast was used for patients with a history of nonresponse to biologics and was favored for patients with relatively low PASI (<10) and a high DLQI.
Collapse
Affiliation(s)
- Julian Distel
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - S Morteza Seyed Jafari
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Vladimir Emelianov
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nikhil Yawalkar
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, University Hospital of Bern, University of Bern, Bern, Switzerland
| |
Collapse
|
10
|
Kartal SP, Çelik G, Yılmaz O, Öksüm Solak E, Demirbağ Gül B, Üstünbaş TK, Gönülal M, Baysak S, Yüksel Eİ, Ünlü B, Güven M, Bozdağ A, Çınar G, Kartal S, Borlu M, Özden MG, Engin B, Serdaroğlu S, Balcı DD, Doğan B, Çiçek D, Yazıcı AC, Aytekin S, Şendur N, Sarıcaoglu H, Kaçar NG, Doğramacı AC, Dönmez L, Alpsoy E. The impact of COVID-19 pandemic on psoriasis patients, and their immunosuppressive treatment: a cross-sectional multicenter study from Turkey. J DERMATOL TREAT 2021; 33:2137-2144. [PMID: 34030547 DOI: 10.1080/09546634.2021.1927947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immunosuppressive therapy has been a great concern during the pandemic. This study aimed to evaluate the pandemic's impact on psoriasis patients treated with immunosuppressive drugs. MATERIAL AND METHODS The multicenter study was conducted in 14 tertiary dermatology centers. Demographic data, treatment status, disease course, and cases of COVID-19 were evaluated in patients with psoriasis using the immunosuppressive treatment. RESULTS Of 1827 patients included, the drug adherence rate was 68.2%. Those receiving anti-interleukin (anti-IL) drugs were more likely to continue treatment than patients receiving conventional drugs (OR = 1.50, 95% CI, 1.181-1.895, p = .001). Disease worsening rate was 24.2% and drug dose reduction increased this rate 3.26 and drug withdrawal 8.71 times. Receiving anti-TNF or anti-IL drugs was associated with less disease worsening compared to conventional drugs (p = .038, p = .032; respectively). Drug withdrawal causes were 'unable to come' (39.6%), 'COVID concern' (25.3%), and 'physician's and patient's co-decision' (17.4%). Four patients had COVID-19 infection with mild symptoms. The incidence was 0.0022% while it was 0.0025% in the general population. CONCLUSION Our study shows that psoriasis patients using systemic immunosuppressive do not have a higher, but even lower COVID-19 risk than the general population, and treatment compliance with biological drugs is higher.
Collapse
Affiliation(s)
- Selda Pelin Kartal
- Department of Dermatology, University of Health Sciences Turkey, Dışkapı Education and Research Hospital, Ankara, Turkey
| | - Gökçen Çelik
- Polatlı State Hospital, Dermatology Clinic, Ankara, Turkey
| | - Oğuz Yılmaz
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Eda Öksüm Solak
- Department of Dermatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Büşra Demirbağ Gül
- Department of Dermatology, Ondokuzmayıs University Faculty of Medicine, Samsun, Turkey
| | - Tuba Kevser Üstünbaş
- Department of Dermatology, Cerrrahpaşa University, Faculty of Medicine, Istanbul, Turkey
| | - Melis Gönülal
- Tepecik Education and Research Hospital Department of Dermatology, University of Health Sciences Turkey, İzmir, Turkey
| | - Sevim Baysak
- Department of Dermatology, University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Education and Research Hospital, İstanbul, Turkey
| | - Esma İnan Yüksel
- Department of Dermatology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Begüm Ünlü
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Münevver Güven
- Department of Dermatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Bozdağ
- Department of Dermatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Gökhan Çınar
- Department of Dermatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Selim Kartal
- Department of Dermatology, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Murat Borlu
- Department of Dermatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Müge Güler Özden
- Department of Dermatology, Ondokuzmayıs University Faculty of Medicine, Samsun, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrrahpaşa University, Faculty of Medicine, Istanbul, Turkey
| | - Server Serdaroğlu
- Department of Dermatology, Cerrrahpaşa University, Faculty of Medicine, Istanbul, Turkey
| | - Didem Didar Balcı
- Tepecik Education and Research Hospital Department of Dermatology, University of Health Sciences Turkey, İzmir, Turkey
| | - Bilal Doğan
- Department of Dermatology, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Demet Çiçek
- Department of Dermatology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ayça Cordan Yazıcı
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Sema Aytekin
- Department of Dermatology, University of Health Sciences Turkey, Haydarpaşa Education and Research Hospital, Istanbul, Turkey
| | - Neslihan Şendur
- Department of Dermatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Hayriye Sarıcaoglu
- Department of Dermatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Nida Gelincik Kaçar
- Department of Dermatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | | | - Levent Dönmez
- Department of Public Health, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erkan Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Real-World Treatment Persistence with Biologic Disease-Modifying Antirheumatic Drugs Among German Patients with Psoriatic Arthritis-A Retrospective Database Study. Rheumatol Ther 2021; 8:483-497. [PMID: 33611778 PMCID: PMC7991063 DOI: 10.1007/s40744-021-00286-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To investigate drug survival for biologic disease-modifying antirheumatic drugs (bDMARDs) in a real-world cohort of German adult biologic-naïve patients with psoriatic arthritis (PsA). METHODS Claims data for patients with a diagnosis of PsA, a bDMARD claims record (index date) between 1 January 2014 and 31 December 2017, and no bDMARD prescription for 365 days before the index date were retrospectively analyzed. The primary outcomes were the overall and individual bDMARD persistence rates over 12 months. Nonpersistence was defined as a treatment gap exceeding the days of supply plus 60 days or switching to a bDMARD other than the index therapy. Sensitivity analysis was performed, wherein the treatment gap was found to vary depending on the bDMARD regimen. Kaplan-Meier curves were plotted to determine persistence; the log-rank test was used to evaluate differences in the persistence rate. Factors associated with treatment discontinuation were evaluated using Cox regression analysis. RESULTS Among 10,954 patients with a PsA diagnosis, 348 were eligible. The overall bDMARD persistence rate was 57.5%; individual bDMARD persistence rates were 81.3% for ustekinumab, 66.7% for infliximab, and 60.0% for golimumab. The mean (SD) overall persistence with bDMARDs was 289 (103) days; the mean persistence was 334 (72) days for ustekinumab, 309 (82) days for golimumab, and 305 (92) days for infliximab. The main reasons for nonpersistence were switching to another bDMARD (15.8%) and treatment discontinuation (26.7%). Male gender was significantly associated with a lower risk of treatment discontinuation (hazard ratio 0.54, 95% confidence interval 0.39-0.77; P < 0.001). The sensitivity analysis yielded similar results. CONCLUSION The one-year persistence rate for bDMARDs in German PsA patients is modest, although the persistence rate depends on the bDMARD considered.
Collapse
Affiliation(s)
- Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany.
| | | | | | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
- Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
13
|
Kara Polat A, Oguz Topal I, Aslan Kayıran M, Koku Aksu AE, Aytekin S, Topaloglu Demir F, Ozkok Akbulut T, Kıvanc Altunay I, Ozkur E, Karadag AS. Drug survival and safety profile of acitretin monotherapy in patients with psoriasis: A multicenter retrospective study. Dermatol Ther 2021; 34:e14834. [PMID: 33527603 DOI: 10.1111/dth.14834] [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: 10/16/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/01/2022]
Abstract
Acitretin is a nonimmunosuppresive systemic agent used in the treatment of psoriasis. Despite its frequent use, research on drug survival and adverse effects is limited. This study aims to evaluate drug survival, factors associated with survival, and adverse effects. Database of the six tertiary referral center for psoriasis patients treated with acitretin between November 2014 and April 2020 were retrospectively analyzed. Demographics of patients, adverse effects, and also drug survival were analyzed. Of 412 patients, 61.2% were male, and 38.8% were female. Common clinical adverse effects were cheilitis (71.4%), dry skin (62.5%), and palmoplantar skin peeling (37.2%). High triglyceride and high total cholesterol levels were observed in 50.0% and 49.5% of patients, respectively. Median survival time (95% confidence interval [CI]) was 18 (13.6-22.4) months. Statistically significant risk factors affecting drug discontinuation were having psoriatic arthritis, age under 65, and receiving previous systemic treatment. Drug survival rates were 56.6%, 25.9%, and 19.8% at 1, 5, and 8 years, respectively. Although mucocutaneous adverse effects of the acitretin were quite frequent, severe, life-treatining ones were infrequent. This old, relatively inexpensive and safe treatment remains a good alternative for the treatment of psoriasis.
Collapse
Affiliation(s)
- Asude Kara Polat
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ilteris Oguz Topal
- Department of Dermatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Melek Aslan Kayıran
- Department of Dermatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Filiz Topaloglu Demir
- Department of Dermatology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Tugba Ozkok Akbulut
- Department of Dermatology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ilknur Kıvanc Altunay
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Ozkur
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
14
|
Kromer C, Loewe E, Schaarschmidt ML, Pinter A, Gerdes S, Herr R, Poortinga S, Moessner R, Wilsmann-Theis D. Drug survival in the treatment of generalized pustular psoriasis: A retrospective multicenter study. Dermatol Ther 2021; 34:e14814. [PMID: 33497511 DOI: 10.1111/dth.14814] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 01/03/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening inflammatory skin disease. Our aim was to assess patient and disease characteristics and analyze drug survival rates in the treatment of GPP in a real-life setting. In this retrospective study, 201 treatment series of 86 patients with GPP treated at five University Medical Centers were analyzed. Overall, excellent response was reached in 41.3% of all treatment courses, partial response in 31.4%, and nonresponse in 27.3%. Biological treatment was significantly more effective than non-biological therapies (excellent response: 47.4% vs 35.9%; P = .02). Overall, the median drug survival was 14.0 months (biologicals: 36.0 months vs nonbiologicals: 6.0 months; P < .001). The crude probability of survival was highest for secukinumab (hazard ratio [HR] of drug discontinuation compared with acitretin: 0.22), followed by ixekizumab and ustekinumab (HR: 0.38 each), adalimumab (HR: 0.59), etanercept (HR: 0.62), infliximab (HR: 0.69), cyclosporine (HR: 1.00), acitretin (reference for HR), fumaric acid esters (HR: 1.06), methotrexate (HR: 1.26), and apremilast (HR: 3.44); no drug discontinuation with guselkumab. Our results reveal high efficacy and drug survival, particularly for IL-17 and IL-(12)/23 antagonists. Thus, these biologics may be considered early in the therapeutic algorithm of GPP.
Collapse
Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Emilia Loewe
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | | | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sietske Poortinga
- Department of Dermatology and Allergy, University Bonn, Bonn, Germany
| | - Rotraut Moessner
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | | |
Collapse
|
15
|
Zeb L, Mhaskar R, Lewis S, Patel NS, Sadhwani D, Patel N, Ekhlassi E, Lu Y, Seminario-Vidal L. Real-world drug survival and reasons for treatment discontinuation of biologics and apremilast in patients with psoriasis in an academic center. Dermatol Ther 2021; 34:e14826. [PMID: 33527682 DOI: 10.1111/dth.14826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lawangeen Zeb
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.,Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rahul Mhaskar
- Department of Public Health, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Suzanna Lewis
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Nishit S Patel
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Divya Sadhwani
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Nupur Patel
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Erfon Ekhlassi
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Yuanyuan Lu
- Department of Public Health, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| |
Collapse
|
16
|
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.
Collapse
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
| | | | | |
Collapse
|
17
|
Onsun N, Güneş B, Yabacı A. Retention and survival rate of etanercept in psoriasis over 15 years and patient outcomes during the COVID-19 pandemic: The real-world experience of a single center. Dermatol Ther 2020; 34:e14623. [PMID: 33274541 PMCID: PMC7744860 DOI: 10.1111/dth.14623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
There have been a number of investigations of the efficacy and safety of etanercept. This study was performed to obtain long‐term drug survival data (ie, time to drug discontinuation) for etanercept, and the reasons for its discontinuation. The study population consisted of patients with psoriatic arthritis and psoriasis followed up by our clinic, registered in the Turkish Psoriasis Registry (PSR‐TR) and treated with etanercept for at least 4 weeks between January 1, 2005, and January 31, 2020. The efficacy of etanercept was evaluated in terms of the Psoriasis Area and Severity Index (PASI) 75, PASI 90 and PASI 100 response rates at 12, 24, 36, and 48 weeks, and annually thereafter. The behaviors of the patients with respect to the use of etanercept, and the outcomes of those who continued to use it during the COVID‐19 pandemic, were also investigated.
Collapse
Affiliation(s)
- Nahide Onsun
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Begüm Güneş
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayşegül Yabacı
- Department of Bioistatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
18
|
Schots L, Grine L, Soenen R, Lambert J. Dermatologists on the medical need for therapeutic drug monitoring of biologics in psoriasis: results of a structured survey. J DERMATOL TREAT 2020; 33:1473-1481. [PMID: 33019835 DOI: 10.1080/09546634.2020.1832649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) may lead to more rational use of biologics. Still, TDM is largely underexplored in psoriasis. Little is known about the dosing behavior of biologics by dermatologists, and their attitude toward TDM. OBJECTIVE Exploration of the awareness and need for the concept of TDM in psoriasis amongst (inter)national dermatologists. METHOD A survey was distributed at the Belgian Dermatology Days 2019 and Skin Inflammation & Psoriasis International Network (SPIN) Congress 2019. Next, an online survey version was launched amongst the SPIN Scientific Committee members. We collected physician's characteristics, prescription behavior of biologics, data regarding clinical response to biologics and attitude toward TDM. RESULTS A total of 107 surveys were included for analysis. Most dermatologists were Belgium-based (54.2%), others from European (23.4%) or non-European countries (19.6%). Seventy percent performed either dose increase (64.8%), time interval shortening (74.6%), dose lowering (16.9%) or time interval extension (33.8%). The majority who performed dose adaptations acknowledged the need for TDM. CONCLUSION This study showed most dermatologists perform dose adaptations empirically. The need for TDM was indicated by the majority, implying the need for effective communication regarding availability, utility and implementation of TDM assays in daily dermatology practice.
Collapse
Affiliation(s)
- Lisa Schots
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Rani Soenen
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| |
Collapse
|
19
|
Sondermann W, Herz S, Sody E, Körber A. Dermatological complications of therapy with biologics in inflammatory autoimmune diseases. J Dtsch Dermatol Ges 2020; 17:1029-1037. [PMID: 31631555 DOI: 10.1111/ddg.13964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Cutaneous adverse events (CAEs) occur in up to 10 % of patients with immune-mediated inflammatory disease (IMID) treated with antitumor necrosis factor (TNF)α agents. The aim of this clinical study was to track and observe the course of CAEs in all biologic therapies. PATIENTS AND METHODS The population for this study consisted of patients with CAEs under biologic therapy who were examined by experienced board-certified dermatologists in the outpatient department of the University Hospital Essen, Department of Dermatology. RESULTS Altogether 39 patients with a total of 45 CAEs were included in this study. In 60 % of the cases a form of paradoxical psoriasis was diagnosed. Two thirds (66.6 %) of the patients with CAEs were diagnosed with an underlying inflammatory bowel disease (IBD). TNFα antagonists were the triggering agents in about 95 % of the cases. Changes in biological therapy were required in nearly half of the cases (46.2 %). Almost 90 % of the patients had either a complete (42.1 %) or a partial response (47 %). CONCLUSIONS Management of CEAs under biological therapy can be challenging in clinical practice. Case discussions between gastroenterologists, rheumatologists and dermatologists should be undertaken to best manage patients with CAEs and avoid unnecessary changes of therapy.
Collapse
Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Saskia Herz
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Elsa Sody
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Körber
- Hautärzte RÜ 143, Rüttenscheider Str. 143, 45130, Essen, Germany
| |
Collapse
|
20
|
Balak DMW, Gerdes S, Parodi A, Salgado-Boquete L. Long-term Safety of Oral Systemic Therapies for Psoriasis: A Comprehensive Review of the Literature. Dermatol Ther (Heidelb) 2020; 10:589-613. [PMID: 32529393 PMCID: PMC7367959 DOI: 10.1007/s13555-020-00409-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 01/10/2023] Open
Abstract
Oral systemic therapies are important treatment options for patients with moderate-to-severe psoriasis, either as monotherapy or in therapy-recalcitrant cases as combination therapy with phototherapy, other oral systemics or biologics. Long-term treatment is needed to maintain sufficient disease control in psoriasis, but continuous use of systemic treatments is limited by adverse events (AEs) and cumulative toxicity risks. The primary aim of this comprehensive literature review was to examine the long-term safety profiles of oral agents commonly used in the treatment of adults with psoriasis. Searches were conducted in EMBASE and PubMed up to November 2018, and 157 relevant publications were included. Long-term treatment with acitretin could be associated with skeletal toxicity and hepatotoxicity, although evidence for skeletal toxicity is mixed and hepatotoxicity is rare, particularly at low doses. Other safety issues include hyperlipidaemia and potential for teratogenicity up to 2-3 years after discontinuation of treatment. There is a paucity of data on long-term treatment with apremilast. Continued exposure to apremilast does not seem to increase the incidence of common AEs, such as gastrointestinal (GI) AEs, upper respiratory tract infections and headache, while the long-term risks for depression, suicidal thoughts and weight loss are unknown. Long-term ciclosporin treatment is associated with renal toxicity, hypertension, non-melanoma skin cancer, neurological AEs and GI AEs. Long-term methotrexate treatment is associated with hepatotoxicity, GI AEs, haematological toxicity, renal toxicity and alopecia. Finally, long-term treatment with fumaric acid esters (FAE) is associated with GI AEs, flushing, lymphocytopenia, proteinuria and elevated liver enzymes. Median drug survival estimates varied considerably: ~ 2.9-9.7 months for apremilast; ~ 5.4 months for ciclosporin; ~ 8.6 months for acitretin; ~ 12.1-21.6 months for methotrexate; and ~ 54.8 months for FAE. These long-term safety profiles may help to guide clinicians to select the optimal oral systemic treatment for the long-term treatment of psoriasis in adults.
Collapse
Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, the Netherlands.
| | - Sascha Gerdes
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Aurora Parodi
- DiSSal Section of Dermatology, University of Genoa-Ospedale-Policlinico San Martino IRCCS, Genoa, Italy
| | - Laura Salgado-Boquete
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| |
Collapse
|
21
|
Vakirlis E, Bakirtzi K, Papadimitriou I, Vrani F, Sideris N, Lallas A, Ioannides D, Sotiriou E. Treatment adherence in psoriatic patients during COVID-19 pandemic: Real-world data from a tertiary hospital in Greece. J Eur Acad Dermatol Venereol 2020; 34:e673-e675. [PMID: 32558015 PMCID: PMC7323240 DOI: 10.1111/jdv.16759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- E Vakirlis
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Bakirtzi
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Papadimitriou
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - F Vrani
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Sideris
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Ioannides
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Sotiriou
- 1st Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
22
|
Marsili F, Travaglini M, Stinco G, Manzoni R, Tiberio R, Prignano F, Mazzotta A, Cannavò SP, Cuccia A, Germino M, Bongiorno MR, Persechino S, Florio T, Pettinato M, Tabanelli M, Sarkar R, Aloisi E, Bartezaghi M, Orsenigo R. Effectiveness of cyclosporine A in patients with moderate to severe plaque psoriasis in a real-life clinical setting in Italy: the TRANSITION study. J DERMATOL TREAT 2020; 33:401-407. [PMID: 32349568 DOI: 10.1080/09546634.2020.1757017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Cyclosporine A (CsA) is one of the systemic therapeutic options for moderate-to-severe psoriasis, based on its efficacy and rapidity of action. The current study investigated the response to CsA in patients with moderate-to-severe plaque psoriasis.Materials and Methods: TRANSITION was an observational, cross-sectional, multicentre study which evaluated the proportion of partial- and suboptimal-responders among patients with moderate-to-severe plaque psoriasis treated with continuous CsA for ≥12 weeks. Patients demonstrating a Psoriasis Area and Severity Index (PASI) response of ≥90, ≥75 and <90, ≥50 and <75 and <50 were defined as responders, suboptimal-responders, partial-responders, and non-responders, respectively.Results: A total of 196 patients (mean age, 46.6 years; 62.8% males) from 14 sites in Italy were evaluated. At the study visit, the mean (SD) PASI score was 4.2(5.5) compared with 15.3(7.1) prior to the last CsA cycle. For response categories, 39.8%, 22.4%, 16.8%, and 20.9% of patients were responders, suboptimal-responders, partial-responders, and non-responders to CsA treatment. Overall, 28.6% of patients permanently discontinued treatment with CsA (lack of efficacy [10.2%], poor tolerability and voluntary discontinuation [3.6% each], and other [11.7%]).Conclusion: Patients were only partially satisfied with CsA treatment, reporting measurable impact on quality of life. Only 40% patients showed a satisfactory response to CsA.
Collapse
Affiliation(s)
- F Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - M Travaglini
- Centro per la cura della Psoriasi, Hospital "Di Summa-Perrino", Brindisi, Italy
| | - G Stinco
- Institute of Dermatology, Department of Medicine, University Hospital, Udine, Italy
| | - R Manzoni
- Division of Dermatology, Azienda Sanitaria Locale of Biella, Ponderano, Italy
| | - R Tiberio
- SCDU Dermatology, AOU Maggiore della Carità, Novara, Italy
| | - F Prignano
- Department of Health Science Dermatology Unit, University of Florence, Firenze, Italy
| | - A Mazzotta
- Dermatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - S P Cannavò
- Dermatology Unit, University Hospital Policlinico "G. Martino", Messina, Italy
| | - A Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - M Germino
- Department of Dermatology, Hospital Policlinico Città di Udine, Udine, Italy
| | - M R Bongiorno
- Dermatology Unit, University Hospital Policlinico "P. Giaccone", Palermo, Italy
| | - S Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - T Florio
- Dermatology Unit, Hospital Di Venere-Carbonara di Bari, Bari, Italy
| | - M Pettinato
- Dermatology Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - M Tabanelli
- U.O.C. Dermatologia Ravenna AUSL Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - R Sarkar
- Novartis Pharma AG, Basel, Switzerland
| | - E Aloisi
- Novartis Farma SpA, Origgio, Italy
| | | | | |
Collapse
|
23
|
Grine L, de la Brassinne M, Ghislain P, Hillary T, Lambert J, Segaert S, Willaert F, Lambert J. A Belgian consensus on the definition of a treat-to-target outcome set in psoriasis management. J Eur Acad Dermatol Venereol 2020; 34:676-684. [PMID: 31749264 PMCID: PMC7154521 DOI: 10.1111/jdv.16104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Treat-to-target (T2T) is an algorithm to reach a predefined outcome. Here, we define a T2T outcome for moderate-to-severe psoriasis vulgaris. METHODS Briefly, the study included a literature review, discussions with key opinion leaders, recruitment of additional dermatologists with experience in managing moderate-to-severe psoriasis, 3 eDelphi survey rounds and a patient focus group. Relevant topics were selected during discussions prior to the survey for the statements. Surveys were based on the eDelphi methodology for consensus-building using a series of statements. Consensus was defined as at least 80% of participants agreeing. A psoriasis patient focus group provided feedback on topic selection and outcome. RESULTS A total of 5 discussions were held, and 3 eDelphi rounds were conducted with an average of 19 participants per round. The T2T outcome was set assuming shared decision between patient and dermatologist, awareness and referral for comorbidities by the dermatologist and appropriate treatment adherence by the patient. We defined 'ideal' and 'acceptable' targets; the latter referring to conditions restricting certain drugs. The T2T outcome was multidimensional, including ≥ ΔPASI90/75 or PGA ≤ 1, itch VAS score ≤ 1, absence of disturbing lesions, DLQI ≤ 1/3, incapacity daily functioning VAS score ≤ 1, safety ≤ mild side-effects and full/mild tolerability of treatment for the ideal and acceptable target, respectively. Finally, time to achieve the T2T outcome was set at 12 weeks after initiation for all treatments. At all times, safety should not exceed the presence of mild side-effects. CONCLUSION With this novel T2T composite outcome for psoriasis, clinicians and patients can make shared decisions on the treatment goals they envisage, as a guidance for future treatment steps - leading to a tight control management of the disease.
Collapse
Affiliation(s)
- L. Grine
- DermatologyGhent University HospitalGhentBelgium
- Head & SkinGhent UniversityGhentBelgium
| | | | - P.‐D. Ghislain
- DermatologyCliniques Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - T. Hillary
- DermatologyUniversity Hospital LeuvenLeuvenBelgium
| | - J. Lambert
- DermatologyUniversity Hospital of AntwerpAntwerpBelgium
| | | | - F. Willaert
- DermatologyErasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | - J. Lambert
- DermatologyGhent University HospitalGhentBelgium
- Head & SkinGhent UniversityGhentBelgium
| |
Collapse
|
24
|
Balak DMW, Carrascosa JM, Gregoriou S, Calzavara-Pinton P, Bewley A, Antunes J, Nyeland ME, Viola MG, Sawyer LM, Becla L. Cost per PASI-75 responder of calcipotriol plus betamethasone dipropionate cutaneous foam versus nonbiologic systemic therapies for the treatment of plaque psoriasis in seven European countries. J DERMATOL TREAT 2020; 32:701-708. [PMID: 31940225 DOI: 10.1080/09546634.2019.1707754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To compare the short-term cost and effectiveness of calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam against nonbiologic systemics in psoriasis patients for whom oral systemic or topical therapy is considered appropriate in seven European countries.Methods: Matching-adjusted indirect comparisons of four-week PASI-75 responses of Cal/BD foam were performed versus 12-week responses of methotrexate, acitretin, fumaric acid esters (FAE) and 16-week responses of apremilast. Analyses took a payer perspective and included drug, physician visit and monitoring costs.Results: In all countries, Cal/BD foam generated the lowest cost per responder (CPR). Against methotrexate, apremilast and acitretin, Cal/BD foam generated response for less than €190 in Italy, €195 in Portugal, €216 in Greece, £218 in the United Kingdom, €250 in Belgium, €319 in Spain, and €359 in the Netherlands. Relative to treatment with FAE, Cal/BD foam resulted in response for less than €298, €430, €382 and £262 in Belgium, the Netherlands, Spain and the United Kingdom, respectively. For Cal/BD foam, apremilast and FAE, total costs were driven by drug costs; for methotrexate and acitretin, by monitoring.Conclusions: Driven by its lower costs and high response rates, Cal/BD foam is likely to be a cost-effective option over the short-term in the investigated psoriasis population.
Collapse
Affiliation(s)
- Deepak M W Balak
- Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jose-Manuel Carrascosa
- Dermatology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, IGTP, Spain
| | - Stamatis Gregoriou
- Department of Dermatology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Sygros Hospital, Athens, Greece
| | | | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Joana Antunes
- Serviço de Dermatologia, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE, Lisbon, Portugal
| | | | | | | | | |
Collapse
|
25
|
Zhukov AS, Khairutdinov VR, Samtsov AV. Precision therapy for psoriasis patients. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/0042-4609-2019-95-6-14-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- A. S. Zhukov
- S. M. Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
| | - V. R. Khairutdinov
- S. M. Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
| | - A. V. Samtsov
- S. M. Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
| |
Collapse
|
26
|
Sondermann W, Herz S, Sody E, Körber A. Dermatologische Komplikationen unter Therapie mit Biologika bei entzündlichen Autoimmunerkrankungen. J Dtsch Dermatol Ges 2019; 17:1029-1038. [DOI: 10.1111/ddg.13964_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Wiebke Sondermann
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum EssenUniversität Duisburg‐Essen Essen
| | - Saskia Herz
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum EssenUniversität Duisburg‐Essen Essen
| | - Elsa Sody
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum EssenUniversität Duisburg‐Essen Essen
| | | |
Collapse
|
27
|
Svedbom A, Ståhle M. Real-world comparative effectiveness of adalimumab, etanercept and methotrexate: a Swedish register analysis. J Eur Acad Dermatol Venereol 2019; 34:525-532. [PMID: 31568598 DOI: 10.1111/jdv.15978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The advent of biosimilars may render etanercept (ETN) and adalimumab (ADA) viable alternatives to methotrexate (MTX) as first-line systemics in psoriasis. However, real-world relative effectiveness data comparing ADA and ETN to MTX are limited. OBJECTIVE To estimate the relative effectiveness of ADA and ETN compared to MTX. METHODS We analysed data from DermaReg, a regional register in Stockholm, Sweden, to estimate drug survival and mean Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) during maintenance treatment. RESULTS A total of 524 patients initiated 727 treatment episodes with ADA, ETN or MTX. After adjusting for confounders, patients treated with ADA had better drug survival (HR: 0.67; P = 0.003), lower mean PASI (-2.0; P < 0.001) and lower mean DLQI (-0.9; P < 0.001) during maintenance treatment compared to patients treated with MTX. The results for ETN compared to MTX were mixed. After adjusting for confounding, there was no significant difference in drug survival (HR 1.23; P = 0.082), but patients on ETN had lower mean PASI (-0.7; P = 0.006) during maintenance treatment. CONCLUSION Adalimumab is superior to MTX in clinical practice whereas the relative effectiveness between ETN and MTX is less clear. This study also highlights the importance of appropriate confounding control in effectiveness analysis.
Collapse
Affiliation(s)
- A Svedbom
- Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Ståhle
- Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Dermatology and Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
28
|
Kromer C, Wilsmann-Theis D, Gerdes S, Philipp S, Schaarschmidt ML, Schmieder A, Dakna M, Arnold T, Peitsch WK, Mössner R. Drug Survival und Gründe für einen Therapieabbruch bei Pustulosis palmoplantaris: Eine retrospektive multizentrische Studie. J Dtsch Dermatol Ges 2019; 17:503-517. [PMID: 31115984 DOI: 10.1111/ddg.13834_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Christian Kromer
- Klinik für Dermatologie, Venerologie und Allergologie, Georg-August-Universität Göttingen
| | | | - Sascha Gerdes
- Psoriasis-Zentrum in der Hautklinik des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - Sandra Philipp
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | - Astrid Schmieder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Mohammed Dakna
- Institut für Medizinische Statistik, Georg-August-Universität Göttingen
| | - Tobias Arnold
- Abteilung für Pneumologie, Theresienkrankenhaus, Mannheim
| | | | - Rotraut Mössner
- Klinik für Dermatologie, Venerologie und Allergologie, Georg-August-Universität Göttingen
| |
Collapse
|
29
|
Mahlich J, Alba A, Hadad LE, Leisten MK, Peitsch WK. Drug Survival of Biological Therapies for Psoriasis Treatment in Germany and Associated Costs: A Retrospective Claims Database Analysis. Adv Ther 2019; 36:1684-1699. [PMID: 31102203 DOI: 10.1007/s12325-019-00969-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Our aim was to study drug survival and associated costs of biologic treatment in a German real-world cohort of biologic-naïve psoriasis patients. METHODS We utilized a German claims database base with 3,682,561 enrolled patients between 2001 and 2015. Kaplan-Meier curves were plotted to show the persistence of different biologics. To determine factors that influence persistence, a Cox regression analysis was performed. In addition, associated costs were calculated 12 months before and after treatment start with biologics. RESULTS Among 75,561 patients with a diagnosis of psoriasis, we identified 347 patients who received a biologic; 176 of them were biologic-naïve prior to initiating therapy. Overall, the 1-year persistence rate was 56%. The highest persistence rate was observed for ustekinumab (80%). Younger patients, and those with a high comorbidity index, had a numerically increased risk of treatment discontinuation. However, parameter values were not statistically significant. While the overall costs after treatment start increased due to the acquisition costs of biologics, we found a strong decrease (- 41%) in sick leave after treatment with biologics had been initiated. CONCLUSION Observed drug survival rates in this real-world setting were relatively low. In line with previous studies, ustekinumab had a higher persistence rate than other biologics. FUNDING Janssen-Cilag.
Collapse
Affiliation(s)
- Jörg Mahlich
- Health Economics and Outcomes Research, Janssen-Cilag, Neuss, Germany.
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| | | | | | | | - Wiebke K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| |
Collapse
|
30
|
Puig L, Carrascosa JM, Daudén E, Sulleiro S, Guisado C. Drug survival of conventional systemic and biologic therapies for moderate-to-severe psoriasis in clinical practice in Spain: prospective results from the SAHARA study. J DERMATOL TREAT 2019; 31:344-351. [DOI: 10.1080/09546634.2019.1597244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José-Manuel Carrascosa
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | | |
Collapse
|
31
|
Bewley A, Shear N, Calzavara‐Pinton P, Hansen J, Nyeland M, Signorovitch J. Calcipotriol plus betamethasone dipropionate aerosol foam vs. apremilast, methotrexate, acitretin or fumaric acid esters for the treatment of plaque psoriasis: a matching-adjusted indirect comparison. J Eur Acad Dermatol Venereol 2019; 33:1107-1115. [PMID: 30472749 PMCID: PMC6766948 DOI: 10.1111/jdv.15369] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Plaque psoriasis has significant impact on patients' quality of life. Topical therapy is considered the treatment mainstay for mild-to-moderate disease according to guidelines. Calcipotriol/betamethasone dipropionate (Cal/BD) [0.005%/0.05%] aerosol foam is indicated for psoriasis vulgaris treatment in adults. Cal/BD foam trials demonstrated improved efficacy and similar safety in this population. Psoriasis treatment is complicated by the broad range of disease presentation, variability and therapeutic options; particularly decisions on transition from topical to non-biologic systemic treatment are difficult. Assessing comparative effectiveness of treatment options provides meaningful value to treatment decisions. OBJECTIVE To compare efficacy of Cal/BD foam individual patient data from pooled trials with efficacy of non-biologic systemic treatments based on aggregated patient characteristics and treatment outcomes. METHODS Individual data from four Cal/BD foam trials in 749 psoriasis patients were pooled to conduct matching-adjusted indirect comparisons. Literature review identified non-biologic systemic treatment trials where methods, populations and outcomes align with Cal/BD foam trials. Of 3090 screened publications, four studies of apremilast, methotrexate, acitretin or fumaric acid esters (FAE) were included. RESULTS After baseline matching, patients treated with 4 weeks of Cal/BD foam had greater Physician's Global Assessment 0/1 response compared to those treated with 16 weeks of apremilast (52.7% vs. 30.4%; P < 0.001). Patients treated with Cal/BD foam had significantly greater Psoriasis Area and Severity Index (PASI) 75 response at Week 4 compared to 16 weeks of apremilast treatment (51.1% vs. 21.6%; P < 0.001). Cal/BD foam patients demonstrated significantly greater PASI 75 response improvements at Week 4 vs. 12 weeks of methotrexate (50.8% vs. 33.5%; P < 0.001) or acitretin (50.9% vs. 31.7%; P = 0.009), and comparable response to FAE (42.4% vs. 47.0%; P = 0.451). CONCLUSIONS Despite recent treatment advances, unmet needs for psoriasis patients remain. Cal/BD foam offers improved efficacy in baseline matched psoriasis patients compared to apremilast, methotrexate or acitretin, and comparable efficacy to FAE.
Collapse
Affiliation(s)
- A.P. Bewley
- Whipps Cross University Hospital & The Royal London Hospital (Barts Health) NHS TrustLondonUK
| | - N.H. Shear
- Sunnybrook Health Sciences CentreTorontoONCanada
| | | | | | | | | |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Kromer C, Wilsmann-Theis D, Gerdes S, Philipp S, Schaarschmidt ML, Schmieder A, Dakna M, Arnold T, Peitsch WK, Mössner R. Drug survival and reasons for drug discontinuation in palmoplantar pustulosis: a retrospective multicenter study. J Dtsch Dermatol Ges 2019; 17:503-516. [PMID: 30994260 PMCID: PMC6850581 DOI: 10.1111/ddg.13834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 01/30/2023]
Abstract
Background Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease‐related to psoriasis. Its treatment is challenging, and little is known about the sustainability of different medications. The aim of this study was to analyze drug survival rates and drug discontinuation in the treatment of PPP under real‐world conditions. Patients and Methods Patients with PPP treated in the dermatology departments of five German university medical centers between 01/2005 and 08/2017 were included in our retrospective study. Drug survival of systemic therapies was assessed with Kaplan‐Meier analysis and multivariate regression. Results Overall, 347 patients with 935 treatment courses were identified. Within the group of non‐biologic systemic agents, apremilast showed the highest median drug survival (15 months), followed by cyclosporine (12 months), the combination of acitretin and topical PUVA (9 months), MTX (8 months), acitretin monotherapy (6 months), alitretinoin (5 months), and fumaric acid esters (3 months). Among biologicals, the highest maintenance rate was detected for certolizumab pegol (restricted mean: 47.4 months), followed by infliximab (median: 26 months), golimumab (22 months), ustekinumab (21 months), adalimumab (18 months), secukinumab (9 months), and etanercept (8 months). Conclusions Biologicals and apremilast may serve as second‐line options for treatment of PPP and should be further evaluated.
Collapse
Affiliation(s)
- Christian Kromer
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sandra Philipp
- Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Astrid Schmieder
- Department of Dermatology, University Medical Center Mannheim, Mannheim, Germany
| | - Mohammed Dakna
- Department of Medical Statistics, Georg- August-University Goettingen, Goettingen, Germany
| | - Tobias Arnold
- Department of Pneumology, Theresienkrankenhaus, Mannheim, Germany
| | | | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| |
Collapse
|
34
|
Hong JR, Lee YW, Choe YB, Ahn KJ. Risk factors for increased serum creatinine level in patients with psoriasis treated with cyclosporine in a real‐world practice. Dermatol Ther 2019; 32:e12875. [DOI: 10.1111/dth.12875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Joo R. Hong
- Department of DermatologyKonkuk University School of Medicine Seoul South Korea
| | - Yang W. Lee
- Department of DermatologyKonkuk University School of Medicine Seoul South Korea
| | - Yong B. Choe
- Department of DermatologyKonkuk University School of Medicine Seoul South Korea
| | - Kyu J. Ahn
- Department of DermatologyKonkuk University School of Medicine Seoul South Korea
| |
Collapse
|
35
|
Mason KJ, Williams S, Yiu ZZN, McElhone K, Ashcroft DM, Kleyn CE, Jabbar-Lopez ZK, Owen CM, Reynolds NJ, Smith CH, Wilson N, Warren RB, Griffiths CEM. Persistence and effectiveness of nonbiologic systemic therapies for moderate-to-severe psoriasis in adults: a systematic review. Br J Dermatol 2019; 181:256-264. [PMID: 30628069 PMCID: PMC6766878 DOI: 10.1111/bjd.17625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2019] [Indexed: 12/17/2022]
Abstract
Background The persistence and effectiveness of systemic therapies for moderate‐to‐severe psoriasis in current clinical practice are poorly characterized. Objectives To systematically review observational studies investigating the persistence and effectiveness of acitretin, ciclosporin, fumaric acid esters (FAE) and methotrexate, involving at least 100 adult patients with moderate‐to‐severe psoriasis, exposed to therapy for ≥ 3 months. Methods MEDLINE, Embase, the Cochrane Library and PubMed were searched from 1 January 2007 to 1 November 2017 for observational studies reporting on persistence (therapy duration or the proportion of patients discontinuing therapy during follow‐up) or effectiveness [improvements in Psoriasis Area and Severity Index (PASI) or Physician's Global Assessment (PGA)]. This review was registered with PROSPERO, number CRD42018099771. Results Of 411 identified studies, eight involving 4624 patients with psoriasis were included. Variations in the definitions and analyses of persistence and effectiveness outcomes prevented a meta‐analysis from being conducted. One prospective multicentre study reported drug survival probabilities of 23% (ciclosporin), 42% (acitretin) and 50% (methotrexate) at 1 year. Effectiveness outcomes were not reported for either acitretin or ciclosporin. The persistence and effectiveness of FAE and methotrexate were better characterized, but mean discontinuation times ranged from 28 to 50 months for FAE and 7·7 to 22·3 months for methotrexate. At 12 months of follow‐up, three studies reported that 76% (FAE), 53% (methotrexate) and 59% (methotrexate) of patients achieved ≥ 75% reduction in PASI, and one reported that 76% of FAE‐exposed patients achieved a markedly improved or clear PGA. Conclusions The comparative persistence and effectiveness of acitretin, ciclosporin, FAE and methotrexate in real‐world clinical practice in the past decade cannot be well described due to the inconsistency of the methods used. What's already known about this topic? Research examining acitretin, ciclosporin, fumaric acid esters (FAE) and methotrexate for the treatment of moderate‐to‐severe psoriasis has focused on safety and efficacy in randomized controlled trials. The persistence and effectiveness of acitretin, ciclosporin, FAE and methotrexate since the introduction of biologic therapies in real‐world clinical practice are poorly understood.
What does this study add? This systematic review examines the persistence and effectiveness of methotrexate, acitretin, ciclosporin and FAE for moderate‐to‐severe psoriasis. Data on the persistence and effectiveness of systemic therapies are lacking, particularly for acitretin and ciclosporin. The definitions of persistence and reporting of effectiveness are inconsistent. Further good‐quality observational studies are needed to explore the real‐world persistence and effectiveness of systemic treatments used for psoriasis.
Linked Comment: Garcia-Doval and Sbidian. Br J Dermatol 2019; 181:237. Plain language summary available online
Collapse
Affiliation(s)
- K J Mason
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - S Williams
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, the University of Manchester, Manchester, U.K
| | - K McElhone
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, the University of Manchester, Manchester, U.K
| | - C E Kleyn
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - Z K Jabbar-Lopez
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - C M Owen
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, U.K
| | - N J Reynolds
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K.,Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - N Wilson
- Institute of Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, the University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| |
Collapse
|
36
|
Heath MS, Kolli SS, Dowling JR, Cline A, Feldman SR. Pharmacotherapeutic strategies for standard treatment-resistant psoriasis. Expert Opin Pharmacother 2018; 20:443-454. [DOI: 10.1080/14656566.2018.1559819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Michael S. Heath
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sree S. Kolli
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica R. Dowling
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Abigail Cline
- 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
| |
Collapse
|
37
|
Chularojanamontri L, Silpa-Archa N, Wongpraparut C, Limphoka P. Long-term safety and drug survival of acitretin in psoriasis: a retrospective observational study. Int J Dermatol 2018; 58:593-599. [PMID: 30548592 DOI: 10.1111/ijd.14349] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND This retrospective observational study aimed to investigate the long-term safety, drug survival, and factors associated with the survival of acitretin in a real-world setting. METHODS Data of adult patients with psoriasis who attended Siriraj Hospital between 2012 and 2017 and were treated with acitretin were reviewed. Demographic data and clinical courses were recorded. The Kaplan-Meier curve and Cox regression were used to calculate drug survival and the factors associated with drug survival, respectively. RESULTS Of 104 patients, 56 and 48 were male and female, respectively, with a mean treatment duration of 3.2 years. The mean cumulative dose per patient was 19.28 ± 7.84 mg/day. Acitretin was administered to 73, 39, 24, and six patients for more than 1, 3, 5, and 10 years, respectively. Most side effects were mild and tolerable; only nine patients withdrew acitretin due to side effects. No patients developed clinical features of cirrhosis or uncontrolled hyperlipidemia. The drug survival rates were 79%, 69.5%, 61.2%, 57.6%, and 53.5% at 1, 2, 3, 4, and 5 years, respectively, higher than those of previous studies. Patients without obesity, metabolic syndrome, and dyslipidemia did not have a significantly longer acitretin survival compared to patients with these comorbidities. CONCLUSIONS Long-term, low-dose acitretin in patients with psoriasis is unlikely to cause significant liver or lipid problems. In countries with difficulty accessing biological agents for psoriasis, acitretin may have a high drug survival rate due to its long-term safety. This study has several limitations: its retrospective nature, single-center study design, and small sample size.
Collapse
Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichaya Limphoka
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Dickel H, Bruckner T, Altmeyer P. Long-term real-life safety profile and effectiveness of fumaric acid esters in psoriasis patients: a single-centre, retrospective, observational study. J Eur Acad Dermatol Venereol 2018; 32:1710-1727. [PMID: 29705996 PMCID: PMC6221124 DOI: 10.1111/jdv.15019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fumaric acid esters (FAEs) are an established systemic treatment for moderate-to-severe psoriasis. However, the long-term clinical safety and effectiveness of continuous FAE monotherapy and combination therapy have not been established. OBJECTIVE To examine the long-term safety and effectiveness of FAEs as monotherapy and in combination with phototherapy or methotrexate in patients with psoriasis treated at a single centre in Germany. METHODS This monocentric, retrospective observational study, with a follow-up period of up to 32.5 years, included 859 patients: 626 received FAE monotherapy, 123 received FAEs with concomitant phototherapy and 110 received FAEs with methotrexate. RESULTS Approximately half of patients (49.0%) reported adverse events (566 total events), most of which involved the gastrointestinal tract. Serious adverse events were reported in 2.3% of patients, but none were deemed to have a causal relationship with any of the treatment regimens. Adverse events leading to treatment discontinuation were observed in 12.9% of patients. A median duration of 1 year was observed in all three treatment subcohorts (P = 0.70) from initiation of FAE treatment to a 50% response rate, where response was defined as achieving a cumulative static Physician's Global Assessment (PGA) score of 'light' and at least a 2-point reduction in baseline PGA. A 50% response rate for the cumulative Psoriasis Area and Severity Index 75 was achieved in the FAE monotherapy subcohort after a median of 3 years of treatment, in the FAEs + phototherapy subcohort after 6.7 years and in the FAEs + methotrexate subcohort after 8.1 years (P = 0.001). CONCLUSION According to our data, FAEs as monotherapy or in combination with phototherapy or methotrexate are safe and beneficial for long-term clinical use. However, multicentre, randomized controlled trials are required to establish the clinical value of monotherapy versus combination therapy and the optimal treatment duration.
Collapse
Affiliation(s)
- H. Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - T. Bruckner
- Institute of Medical Biometry and Informatics (IMBI)University Hospital HeidelbergHeidelbergGermany
| | - P. Altmeyer
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
- Dermatology Practice at City ParkBochumGermany
| |
Collapse
|
40
|
Sruamsiri R, Iwasaki K, Tang W, Mahlich J. Persistence rates and medical costs of biological therapies for psoriasis treatment in Japan: a real-world data study using a claims database. BMC DERMATOLOGY 2018; 18:5. [PMID: 29996929 PMCID: PMC6042444 DOI: 10.1186/s12895-018-0074-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/03/2018] [Indexed: 11/10/2022]
Abstract
Background Biological therapies (BTs) including infliximab (IFX), adalimumab (ADL), secukinumab (SCK) and ustekinumab (UST) are approved in Japan for the treatment of psoriasis. Although the persistence rates and medical costs of BTs treatment have been investigated in multiple foreign studies in recent years, few such studies have been conducted in Japan and the differences between patients who adhered to treatment and those who did not have not been reported. This study is aimed at investigating the persistence rates and medical costs of BTs in the treatment of psoriasis in Japan, using the real-world data from a large-scale claims database. Methods Claims data from the JMDC database (August 2009 to December 2016) were used for this analysis. Patient data were extracted using the ICD10 code for psoriasis and claims records of BT injections. Twelve-month and 24-month persistence rates of BTs were estimated by Kaplan-Meier methodology, and 12-month-medical costs before and after BT initiation were compared between persistent and non-persistent patient groups at 12 months. Results A total of 205 psoriasis patients treated with BTs (BT-naïve patients: 177) were identified. The 12-month/24-month persistence rates for ADL, IFX, SCK, and UST in BT-naïve patients were 46.8% ± 16.6%/46.8 ± 16.6%, 53.0% ± 14.9%/41.0% ± 15.5%, 55.4%/55.4% (95% CI not available) and 79.4% ± 9.9%/71.9% ± 12.2%, respectively. Statistically significant differences in persistence were found among different BT treatments, and UST was found to have the highest persistence rate. The total medical costs during the 12 months after BT initiation in BT-naïve patients were (in 1000 Japanese Yen): 2218 for ADL, 3409 for IFX, 465 for SCK, 2824 for UST (average: 2828). Compared with the 12-month persistent patient group, the total medical costs in the persistent group was higher (Δ:+ 118), but for some medications such as IFX or UST cost increases were lower for persistent patients. Conclusions UST was found to have the highest persistence rate among all BTs for psoriasis treatment in Japan. The 12-month medical costs after BT initiation in the persistent patient group may not have increased as much as in the non-persistent patient group for some medications. Electronic supplementary material The online version of this article (10.1186/s12895-018-0074-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | | | | | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen-Cilag GmbH, Johnson & Johnson Platz 1, Neuss, 41470, Germany. .,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| |
Collapse
|
41
|
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
|
42
|
Marcianò I, Randazzo MP, Panagia P, Intelisano R, Sgroi C, Ientile V, Cannavò S, Guarneri C, Reitano P, Spina E, Trifirò G. Real-world use of biological drugs in patients with psoriasis/psoriatic arthritis: a retrospective, population-based study of years 2010-2014 from Southern Italy. GIORN ITAL DERMAT V 2018; 155:441-451. [PMID: 29582617 DOI: 10.23736/s0392-0488.18.05753-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Biological drugs, such as infliximab, etanercept, adalimumab, ustekinumab, golimumab and certolizumab are third-line therapy for psoriasis (PsO) and psoriatic arthritis (PsA), but they may be used at earlier stage in severe forms. This study investigated the pattern of use and costs of biological drugs for PsO/PsA in a large population from Southern Italy during the years 2010-2014. METHODS This was a retrospective, population-based, drug-utilization study, using healthcare administrative databases of the ASL (Local Health Unit) and two hospitals of Messina Province (Sicily) in the years 2010-2014. Incident users of adalimumab, ustekinumab, infliximab, etanercept and golimumab for PsO/PsA were characterized. Yearly prevalence of use and costs, as well as time to treatment discontinuation and switch were assessed. RESULTS During the study period, 517 patients received at least one study drugs prescription for PsO/PsA and 304 (58.8%) were incident users, mostly treated with adalimumab (33.6%). Incident users were mostly males (59.8%), with a median age of 49 years. The prevalence of biological drugs users in PsO/PsA increased from 4.3 to 6.9 per 10,000 inhabitants from 2011 to 2014. Pharmaceutical expenditure of the study drugs almost doubled (from 2.6 to 4.7 million euros over 5 years of observation). During the first year of treatment, discontinuation occurred in 31.8% of incident users and switch was not infrequent (7.4%). CONCLUSIONS Prevalence of use and costs of biological drugs for PsO/PsA substantially increased in recent years in a large population of Southern Italy. Larger uptake of lowest cost biological drugs, and biosimilars whenever available, may help access to the most innovative drugs.
Collapse
Affiliation(s)
| | | | | | | | - Carmela Sgroi
- Department of Pharmaceutics, ASL Messina, Messina, Italy
| | | | - Serafinella Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Edoardo Spina
- G. Martino University Hospital, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- G. Martino University Hospital, Messina, Italy - .,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
|
46
|
Haneke E. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management. PSORIASIS (AUCKLAND, N.Z.) 2017; 7:51-63. [PMID: 29387608 PMCID: PMC5774607 DOI: 10.2147/ptt.s126281] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy, nail bed involvement may cause salmon spots, subungual hyperkeratosis, and splinter hemorrhages, and psoriasis of the distal nail bed and hyponychium causes onycholysis whereas that of the proximal nail fold causes psoriatic paronychia. The more extensive the involvement, the more severe is the nail destruction. Pustular psoriasis may be seen as yellow spots under the nail or, in case of acrodermatitis continua suppurativa, as an insidious progressive loss of the nail organ. Nail psoriasis has a severe impact on quality of life and may interfere with professional and other activities. Management includes patient counseling, avoidance of stress and strain to the nail apparatus, and different types of treatment. Topical therapy may be tried but is rarely sufficiently efficient. Perilesional injections with corticosteroids and methotrexate are often beneficial but may be painful and cannot be applied to many nails. All systemic treatments clearing widespread skin lesions usually also clear the nail lesions. Recently, biologicals were introduced into nail psoriasis treatment and found to be very effective. However, their use is restricted to severe cases due to high cost and potential systemic adverse effects.
Collapse
Affiliation(s)
- Eckart Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland
- Dermatology Practice Dermaticum, Freiburg, Germany
- Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal
- Department of Dermatology, University Hospital, Gent, Belgium
| |
Collapse
|
47
|
Schön MP. Es hört doch jeder nur, was er versteht. J Dtsch Dermatol Ges 2016; 14:1055-1056. [DOI: 10.1111/ddg.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|