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Chiu HY, Hui RCY, Tsai TF, Chen YC, Chang Liao NF, Chen PH, Lai PJ, Wang TS, Huang YH. Predictors of time to relapse following ustekinumab withdrawal in patients with psoriasis who had responded to therapy: An 8-year multicenter study. J Am Acad Dermatol 2023; 88:71-78. [PMID: 30703455 DOI: 10.1016/j.jaad.2019.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/13/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on predictors and time to relapse in patients with psoriasis who discontinue therapy in a real-world setting are scarce. OBJECTIVE To investigate predictors of relapse after withdrawal of ustekinumab in patients with psoriasis. METHOD This study screened 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018. Overall, 202 patients (accounting for 304 treatment episodes) who had responded to therapy and were withdrawn from ustekinumab treatment were included. RESULTS The cumulative probabilities of being relapse-free at 6, 12, 18, 24, and 36 months after withdrawal from ustekinumab treatment were 49.3%, 12.6%, 5.3%, 4.7%, and 1.6%, respectively. Multivariate regression analyses with a generalized estimating equation showed that after adjustments, biologic-naive status, maximum improvement in Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50% improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab were significant predictors of time to relapse following discontinuation of ustekinumab. LIMITATION Nonrandomized allocation of duration of treatment and follow-up. CONCLUSION Given the high rates of relapse, withdrawal of ustekinumab from patients with well-controlled psoriasis cannot be recommended.
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Affiliation(s)
- Hsien-Yi Chiu
- Department of Dermatology and Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology and Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
| | | | - Po-Hua Chen
- Department of Dermatology and Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Po-Ju Lai
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology and Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Taiwan.
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Ger TY, Huang YH, Hui RCY, Tsai TF, Chiu HY. Effectiveness and safety of secukinumab for psoriasis in real-world practice: analysis of subgroups stratified by prior biologic failure or reimbursement. Ther Adv Chronic Dis 2019; 10:2040622319843756. [PMID: 31024679 PMCID: PMC6472156 DOI: 10.1177/2040622319843756] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Little is known about the treatment outcomes of secukinumab in clinical
practice, which differ from those in clinical trials. The effectiveness of
biologics may differ in psoriasis patients with previous biologics exposure.
The objective of this study was to investigate the real-world effectiveness
and safety of secukinumab therapy and analyze subgroups stratified by
reimbursement or prior biologic failure. Methods: This retrospective multicenter study collected data from a cohort of 118
consecutive patients who received secukinumab treatment between December
2015 and March 2018. Effectiveness was evaluated by degree of improvement in
the Psoriasis Area and Severity Index (PASI) scores. Adverse events and
reasons for discontinuation were also recorded. Results: The mean PASI improvement rate at weeks 4, 12, 24, and 36 was 63.5%, 77.7%,
78.7%, and 76.0%, respectively. Compared with reimbursed patients,
nonreimbursed patients had a significantly lower baseline PASI and a shorter
mean disease duration of psoriasis; they were more frequently
biologic-naïve, had used less prior traditional antipsoriatic drugs and were
more likely to be treated with secukinumab 150 mg. The effectiveness of
secukinumab in nonreimbursed patients was superior despite higher
discontinuation rates. Compared with patients without prior biologic
failure, patients with prior biologic failure had a significantly lower mean
PASI improvement at weeks 12, 24, 36, and 48. The decline in response rates
to secukinumab tended to be more pronounced for patients who failed
ustekinumab than tumor necrosis factor-α inhibitors. Moreover, the number of
prior biologic failures was associated with a decreased response rate and
increased likelihood of secondary loss of effectiveness of secukinumab
therapy. Conclusion: In a real-life clinical setting, the characteristics of nonreimbursed
patients receiving secukinumab treatment differed from those of reimbursed
patients. The PASI improvement for secukinumab was substantial but lower
than that in clinical trials. The number and classes of prior biologic
failures impact the treatment response to secukinumab.
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Affiliation(s)
- Tzong-Yun Ger
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, No.5, Fuxing Street, Guishan Dist., Taoyuan City 333
| | | | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, NO.25, Lane 442, Section 1, Jingguo Road, Hsinchu City 300
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Safety and efficacy of etanercept monotherapy for moderate-to-severe plaque psoriasis: A prospective 12-week follow-up study. Curr Med Sci 2017; 37:943-947. [PMID: 29270758 DOI: 10.1007/s11596-017-1832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/12/2017] [Indexed: 10/18/2022]
Abstract
Etanercept has been shown to be effective for the treatment of moderate-to-severe plaque psoriasis. Since most clinical trials examined etanercept in combination with other drugs, the efficacy and safety of etanercept monotherapy for moderate-to-severe plaque psoriasis have not been well established. This prospective study enrolled 61 Chinese patients with moderate-to-severe plaque psoriasis to explore the efficacy and safety of etanercept monotherapy. These patients were treated with etanercept at a subcutaneous dose of 25 mg, twice a week, for 12 weeks. All the 61 patients completed the treatment and showed significant improvement in psoriasis area and severity index (PASI) scores. At 4, 8, and 12 weeks after treatment, the response rates (PASI75) were 0%, 21.31%, and 40.98%, respectively. It was concluded that etanercept monotherapy is efficacious and safe for patients with moderate- to-severe plaque psoriasis.
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