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Aguado Vázquez Á, Melgosa Ramos FJ, Alonso Díez C, Mateu Puchades A. Real-World Experience of Secukinumab Dose Optimization in Moderate-to-Severe Psoriasis. Retrospective, Single-Center Series of 11-Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00697-5. [PMID: 39233225 DOI: 10.1016/j.ad.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/14/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2024] Open
Affiliation(s)
- Á Aguado Vázquez
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España.
| | - F J Melgosa Ramos
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| | - C Alonso Díez
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| | - A Mateu Puchades
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
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Kirsten N, Rubant S, Gomis-Kleindienst S, Pfeiffer-Vornkahl H, Augustin M. Treatment adjustment in biologic therapies for moderate-to-severe plaque psoriasis: a German retrospective chart review (TABU). J Dtsch Dermatol Ges 2024. [PMID: 39073011 DOI: 10.1111/ddg.15448] [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: 08/14/2023] [Accepted: 04/05/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Flexible biologic therapy dosing regimens in psoriasis management are common, but data from routine care in Germany are scarce. This study evaluated treatment adjustments for biologic therapies commonly prescribed in Germany. PATIENTS AND METHODS Charts for up to 100 consecutive patients treated at 29 centers were reviewed. Data were extracted for adults (aged 18-65 years) with moderate-to-severe plaque psoriasis treated with adalimumab, guselkumab, ixekizumab, secukinumab, or ustekinumab for ≥ 36 weeks. The primary endpoint was time to first treatment adjustment. Secondary endpoints included frequency of and reasons for treatment adjustments. Time to treatment adjustment was analyzed using Kaplan-Meier methods. RESULTS Among 982 patients, 297 treatment adjustments in 240 (24.4%) patients were identified. The mean (median; interquartile range) time to first treatment adjustment (n = 223) was 8.4 (4.0; 2.0-12.0) months (secukinumab: 14.1 [10.0; 4.0-21.0], adalimumab: 11.0 [7.0; 3.0-14.5], ustekinumab: 11.0 [6.0; 2.0-16.0], ixekizumab: 5.8 [3.0; 2.0-8.5], guselkumab: 5.1 [3.0; 2.0-7.0]). The most frequent adjustment type was starting concomitant treatment(s) (10.4% of patients); insufficient skin effectiveness was the most frequent reason for adjustment. CONCLUSIONS Biological treatment adjustments are frequent in moderate-to-severe psoriasis; flexible dosing regimens would support optimal management.
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Affiliation(s)
- Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Rubant
- Medical Immunology Department, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Daudén E, Escario E, Martos-Cabrera L, Armesto S, Herrera-Acosta E, Vidal D, Vilarrasa E, Rivera R, de la Cueva P, Martorell A, Ballesca F, Belinchón I, Carretero G, Rodríguez L, Romero-Maté A, Pujol-Montcusí J, Salgado L, Sahuquillo-Torralba A, Coto-Segura P, Baniandrés O, Feltes R, Riera-Monroig J, Garrido J, Llamas-Velasco M. Dose reduction is a feasible strategy in patients with plaque psoriasis who achieve sustained response with secukinumab: a retrospective, multicenter cohort study in daily practice setting. Int J Dermatol 2024; 63:503-511. [PMID: 38168847 DOI: 10.1111/ijd.16915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Biological therapy dose modification is a common practice in the long-term treatment of plaque psoriasis. OBJECTIVE The objective of the study was to determine prevalence, characteristics of patients, effectiveness, treatment survival of secukinumab dose reduction (SEC-DR) strategy and assess its safety and cost implications. METHODS A retrospective, observational, multicenter cohort study was conducted in patients with plaque psoriasis treated with secukinumab and up to 2 years of follow-up. RESULTS In 63/347 patients with an initial standard dose regimen, SEC-DR was tried at any moment in 18.2% of them after sustained response. In 51 patients, the interval between administrations was increased while in 12 patients, monthly dose was reduced to 150 mg. Successful SEC-DR was achieved in 77.8% of the patients, with sustained PASI response to the end of the study. Survival of secukinumab treatment and safety profile were not compromised by DR. The use of DR saved 33% of the cost, including failures in which standard treatment was resumed. LIMITATIONS The proper of the study designed and the arbitrary definition of "DR success." CONCLUSION Off-label SEC-DR strategy was used in patients with sustained response to standard dose regimen; this strategy showed long-term efficacy without compromising treatment survival or worsening the safety profile while also being cost saving.
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Affiliation(s)
- Esteban Daudén
- Hospital Universitario de la Princesa. Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Elena Escario
- Hospital Universitario de la Princesa. Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Luisa Martos-Cabrera
- Hospital Universitario de la Princesa. Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Susana Armesto
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David Vidal
- Hospital de Sant Joan Despí Moisés Broggi, Barcelona, Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Ferran Ballesca
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Isabel Belinchón
- Hospital General Universitario de Alicante - ISABIAL, Alicante, Spain
| | | | | | | | - J Pujol-Montcusí
- Hospital Universitario de Tarragona "Joan XXIII", Tarragona, Spain
| | - Laura Salgado
- Complejo Hospitalario Universitario, Pontevedra, Spain
| | | | | | | | - R Feltes
- Hospital Universitario la Paz, Madrid, Spain
| | | | | | - Mar Llamas-Velasco
- Hospital Universitario de la Princesa. Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
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Daudén E, Vidal D, Romero A, Bordel MT, Rivera R, Márquez J, Zamora E, Martinez L, Ocaña MJ, Vila C, Iribarren P, Corona N, Zulaica A. Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:1-9. [PMID: 37429433 DOI: 10.1016/j.ad.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.
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Affiliation(s)
- E Daudén
- Dermatology Department, IIS-IP, Hospital Universitario La Princesa, Madrid, Spain
| | - D Vidal
- Dermatology Department, Hospital Moisés Broggi, Barcelona, Spain
| | - A Romero
- Dermatology Department, Hospital de Fuenlabrada, Madrid, Spain
| | - M T Bordel
- Dermatology Department, Hospital Provincial de Zamora, Zamora, Spain
| | - R Rivera
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Márquez
- Dermatology Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - E Zamora
- Dermatology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - L Martinez
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M J Ocaña
- Dermatology Department, Hospital Universitario San Agustín de Linares, Jaén, Spain
| | - C Vila
- Dermatology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - P Iribarren
- Medical Department, AbbVie Spain, S.L.U., Madrid, Spain
| | - N Corona
- Medical Department, AbbVie Spain, S.L.U., Madrid, Spain
| | - A Zulaica
- Dermatology Department, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain.
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5
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Daudén E, Vidal D, Romero A, Bordel MT, Rivera R, Márquez J, Zamora E, Martinez L, Ocaña MJ, Vila C, Iribarren P, Corona N, Zulaica A. Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T1-T9. [PMID: 37923068 DOI: 10.1016/j.ad.2023.10.031] [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: 05/04/2023] [Accepted: 07/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.
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Affiliation(s)
- E Daudén
- Dermatology Department, IIS-IP, Hospital Universitario La Princesa, Madrid, España
| | - D Vidal
- Dermatology Department, Hospital Moisés Broggi, Barcelona, España
| | - A Romero
- Dermatology Department, Hospital de Fuenlabrada, Madrid, España
| | - M T Bordel
- Dermatology Department, Hospital Provincial de Zamora, Zamora, España
| | - R Rivera
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Márquez
- Dermatology Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, España
| | - E Zamora
- Dermatology Department, Hospital Universitario de Móstoles, Madrid, España
| | - L Martinez
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, España
| | - M J Ocaña
- Dermatology Department, Hospital Universitario San Agustín de Linares, Jaén, España
| | - C Vila
- Dermatology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - P Iribarren
- Medical Department, AbbVie Spain, S.L.U., Madrid, España
| | - N Corona
- Medical Department, AbbVie Spain, S.L.U., Madrid, España
| | - A Zulaica
- Dermatology Department, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, España.
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Perrone V, Losi S, Sabatino S, Mezzetti M, Dovizio M, Sangiorgi D, Degli Esposti L. Analysis of Drug Utilization in Patients with Psoriasis: A Real-World Retrospective Study Among the Italian Population. PSORIASIS (AUCKLAND, N.Z.) 2023; 13:1-9. [PMID: 36891082 PMCID: PMC9987452 DOI: 10.2147/ptt.s396003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
Purpose An Italian real-world retrospective study was conducted in patients with psoriasis (PSO) to evaluate their characteristics, treatment patterns, and biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) drug utilization. Patients and Methods The retrospective analysis was carried out on real-world data collected from administrative databases of selected Italian health-departments; the dataset covered approximately 22% of the Italian population. PSO patients (identified by PSO hospitalization, and/or active exemption code and/or a topical anti-psoriatic medication prescription) were included. In prevalent patients identified during 2017-2018-2019-2020, baseline characteristics and treatment patterns were investigated. Moreover, b/tsDMARD drug utilization (focusing on persistence, monthly dosage, and mean duration between prescriptions) was evaluated in bionaïve patients included during 2015 and 2018. Results PSO was diagnosed in 241,552 (in 2017), 269,856 (in 2018), 293,905 (in 2019) and 301,639 (in 2020) patients. At the index date, almost 50% of patients had not received systemic medications, and 2% had received biological treatment. Among the b/tsDMARD-treated patients, a decrease in the use of tumour necrosis factor (TNF) inhibitors (60.0-36.4%, from 2017 to 2020) and an increase in the use of interleukin (IL) inhibitors (36.3-50.6%, from 2017 to 2020) were observed. In 2018, the persistence rates of TNF inhibitors and IL inhibitors in bionaïve patients ranged from 60.8-79.7% and 83.3-87.9%, respectively. Conclusion This real-world study of PSO drug utilization in Italy showed that a significant number of patients were not treated with systemic medications and only 2% of patients were treated with biologics. An increase in the use of IL inhibitors and a decrease in the prescription of TNF inhibitors over years were found. Patients treated with biologics were highly persistent with treatment. These data provide insight into routine clinical practice for PSO patients in Italy, suggesting that the optimization of treatment for PSO still represents an unmet medical need.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A, Sesto Fiorentino, Italy
| | | | | | - Melania Dovizio
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
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Egeberg A, Freilich J, Stelmaszuk MN, Kongerslev R, Apol E, Hansen JB, Levin L. Real-world dose adjustments of biologic treatments in psoriasis and their economic impact: a Swedish national population study. Clin Exp Dermatol 2022; 47:1968-1975. [PMID: 35670046 PMCID: PMC9826076 DOI: 10.1111/ced.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND To date, evidence on the dose adjustments of biologics in the real-world treatment of psoriasis is limited. However, dose adjustments may have important clinical and economic implications. AIMS To study the dose adjustments of individual biologics over time in real-world practice in Sweden. METHODS A retrospective observational study of adults with moderate to severe psoriasis was conducted based on Swedish national registry data from 2010 to 2018. Treatment episodes were identified for individual patients from the date of drug dispensation to the end of the supply of the drug. Dosing data were expressed as the proportion of treatment episodes with accumulated syringes/vials equal to, above or below the recommended guidelines. Real-world costs were calculated and compared with costs predicted from dosing guidelines. RESULTS The mean dose was above recommended levels for all biologics investigated. Weighted mean dose adjustments for adalimumab, etanercept, secukinumab and ustekinumab were 13%, 23%, 8% and 3%, respectively, over the entire treatment period. Higher doses translate to higher costs, including notable increases over time vs. expected costs for secukinumab. CONCLUSIONS Dose adjustments of biologics are frequent in clinical practice but differ for the various biologics. The mean observed increases in dose above guideline recommendations might indicate perceptions of suboptimal efficacy for biologics, with implications for the cost and cost-effectiveness of these treatments. Further research is warranted to understand the reasons for dose adjustments in clinical practice.
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Affiliation(s)
- Alexander Egeberg
- Department of DermatologyBispebjerg Hospital, University of CopenhagenCopenhagenDenmark
| | - Jonatan Freilich
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden,Parexel InternationalStockholmSweden
| | | | | | | | | | - Lars‐Åke Levin
- Department of Health, Medicine and Caring Sciences (HMV)Linköping UniversityLinköpingSweden
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Gambardella A, Licata G, Sohrt A. Dose Adjustment of Biologic Treatments for Moderate-to-Severe Plaque Psoriasis in the Real World: A Systematic Review. Dermatol Ther (Heidelb) 2021; 11:1141-1156. [PMID: 34081304 PMCID: PMC8322248 DOI: 10.1007/s13555-021-00559-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Dose escalation and reduction of biologic treatments are frequent in clinical practice. The aim of this systematic review is to summarise evidence on dose adjustment of biologic treatments for moderate-to-severe plaque psoriasis in the real-world. METHODS A systematic review of real-world evidence on dose adjustment of biologics for plaque psoriasis was performed. Searches were conducted in BIOSIS Previews®, Embase®, International Pharmaceutical Abstracts, MEDLINE®, and SciSearch® in March 2020. Real-world studies that reported biologic dose adjustment for moderate-to-severe plaque psoriasis were included. RESULTS The search identified 162 papers, and 20 studies with 30,912 patients were included from 2014 to 2020. More studies reported on dose escalation than dose reduction. For adalimumab, 3-54% of patients had dose reduction while 0-37% had dose escalation. For infliximab, only two studies reported a dose reduction, with rates of 22-29%, while dose escalation rates varied from 14 to 67%. Dose reduction rates of 5-49% were reported for etanercept while 0-55% of patients had doses escalated. For ustekinumab, dose escalation and reduction rates ranged from 3 to 37% and 7 to 42%, respectively. Two studies reported on dose adjustment for secukinumab; in one 52% of patients initiated on 150 mg instead of the recommended 300 mg, while another reported no dose increase. CONCLUSIONS Dose adjustment of biologics for psoriasis is common, with escalation more frequently reported than reduction. Dose escalation may have economic and safety consequences, while dose reduction may impact efficacy. These aspects are important to consider when making decisions on treatment dosing.
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Affiliation(s)
| | - Gaetano Licata
- Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy.
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Michielsens CAJ, van Muijen ME, Verhoef LM, van den Reek JMPA, de Jong EMGJ. Dose Tapering of Biologics in Patients with Psoriasis: A Scoping Review. Drugs 2021; 81:349-366. [PMID: 33453052 PMCID: PMC7952351 DOI: 10.1007/s40265-020-01448-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Biologics serve as a cornerstone in psoriasis treatment, with low disease activity or sometimes even clinical remission as a realistic treatment outcome. So far, it is unclear whether biologics should be tapered when this target is achieved. Dose tapering could offer potential benefits by decreasing side effects, the burden of repetitive injections and costs of biological therapy. However, clinical guidelines on dose tapering of biologicals in psoriasis patients are lacking. This scoping review was conducted to provide an overview of the current literature on dose tapering and offer guidance for clinicians in daily clinical practice. Methods Dose tapering is defined as the administration of a lower dose per administration, or the prolongation of the regular dose interval, after initial treatment according to the standard dosing. Four electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) were systematically searched for literature on tapering of biologics in adult patients with psoriasis from 1 January 2000. Results We included 19 original articles on biologic tapering in psoriasis patients: four randomized controlled trials and 15 observational studies. Tapering eligibility criteria, tapering strategies, tapering outcomes, and recapture of response after relapse were assessed. Furthermore, the available evidence on possible predictors for successful tapering, and the effect of tapering on safety, quality of life and costs is summarized. The definition of low disease activity as a measure for tapering eligibility varied widely. Beside tapering criteria, tapering strategies were also heterogeneous. Of note, quality-of-life measurements were barely integrated in the evaluation of tapering outcomes. Literature on regaining response after relapse due to tapering was limited, but restored remission has been described. The included studies did not proclaim a significant effect of tapering on the occurrence of (severe) adverse events. Even though cost savings have been reported, no proper cost-effectiveness analysis has been conducted yet. Conclusion Biologic tapering seems to be effective and safe in psoriasis patients with stable low disease activity or clinical remission. Available data on biologic dose tapering in patients with psoriasis are promising, but more research is warranted to fill the current gaps in knowledge. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-020-01448-z. Biologics are effective in treating psoriasis amongst other diseases, such as rheumatoid arthritis and Crohn’s disease. However, biologics are costly, and can cause side effects, such as an increased risk of infection. In patients with rheumatoid arthritis, it is not uncommon to lower the dose of these biologics (also called “dose tapering”), once stable low disease activity, or even remission, is reached. However, in psoriasis patients, dose tapering of biologics is not common practice. In this “scoping review,” we provide an overview of the available literature on dose tapering of biologics in adult patients with plaque psoriasis in order to address the current gaps in literature. We found 19 studies that addressed dose tapering. These studies used different criteria to determine which patients were eligible for tapering, which led to various interpretations of tapering success. This made it difficult for us to draw general conclusions on which tapering criteria and strategies should be further investigated. Dose tapering seems to be effective and safe in patients with a stable low disease activity, although more (high-quality) research is needed. Future studies should focus on generating more data on long-term safety, finding predictors for successful tapering, calculating the cost-effectiveness of dose tapering, and evaluating dose tapering in the newest generation of biologics.
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Affiliation(s)
- C A J Michielsens
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.
| | - M E van Muijen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - J M P A van den Reek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands
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10
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Pharmacogenetics Update on Biologic Therapy in Psoriasis. ACTA ACUST UNITED AC 2020; 56:medicina56120719. [PMID: 33419370 PMCID: PMC7766592 DOI: 10.3390/medicina56120719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: Psoriasis is a chronic immune-mediated skin disease caused by several complex factors, both environmental and genetic, many of which are still not fully understood. Nowadays, several groups of biological drugs are being used for psoriasis treatment. Although these therapies are very effective, they show significant variability in efficacy among individuals. Therefore, there is a need for biomarkers to predict treatment outcomes in order to guide personalized therapeutic decisions. Pharmacogenetics is the study of variations in DNA sequences related to drug response. Materials and Methods: In this article, we review pharmacogenetics studies on the treatment of moderate-to-severe psoriasis focusing on anti-interleukin (IL) 12/23 (ustekinumab) and anti-IL17 drugs (secukinumab and ixekizumab), as well as recent studies concerning anti-TNF drugs. Results: Several polymorphisms have been studied over the years in reference to anti-TNF drugs; some of the most recent studies included the performance of a genome-wide association study (GWAS) and pharmacogenetics studies focused on the optimization of a treatment regimen. Various polymorphisms in different genes have been related to ustekinumab response; among them, the most commonly studied is the HLA-C*06:02 allele. Conclusions: Although not confirmed in some studies, most studies have shown that patients carrying this allele present a significantly higher response rate to ustekinumab. Some polymorphisms have been studied in patients treated with anti-IL17 drugs, mostly related to secukinumab; however, up to now, no association has been found between any of these polymorphisms and response. Nevertheless, further studies involving larger cohorts are needed in order to confirm these results before the implementation of this biomarker in clinical practice.
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Llamas-Velasco M, Daudén E. Reduced doses of biological therapies in psoriasis may increase efficiency without decreasing drug survival. Dermatol Ther 2020; 33:e14134. [PMID: 32761730 DOI: 10.1111/dth.14134] [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] [Received: 06/29/2020] [Revised: 07/19/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
Abstract
Off-label treatment with reduced doses of biological therapies for moderate-severe psoriasis is used, but its efficacy, safety, and persistence are not well known. We have compared reduced doses with standard an escalated doses and study predictive factors for a successful reduction of doses lasting more than 6 months. We included 303 subcutaneous treatments (33% with reduced doses and 29% with escalated doses). Eighty (80.8%) reduced treatments were successful. Patients with longer evolution of the disease or patients treated with drugs different from adalimumab presented an increased risk of failure. Median drug survival did not differ between the different dosing schedules. Adverse events percentage was higher in the group treated with standard doses. Unlike previous literature, ustekinumab is the drug most commonly used at reduced doses in the present study. We have found similar efficacy rates in patients with dose modification compared with patients with standard dose, without further persistence problems. Our results suggest that reduction of dose should be done early, at the time of reaching a good response (PASI 90 or PASI <3 in two consecutive visits) as this dosing seems to be safe and portends no problems regarding persistence or adverse effects.
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Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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12
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Strober B, Menter A, Leonardi C, Gordon K, Lambert J, Puig L, Photowala H, Longcore M, Zhan T, Foley P. Efficacy of risankizumab in patients with moderate-to-severe plaque psoriasis by baseline demographics, disease characteristics and prior biologic therapy: an integrated analysis of the phase III UltIMMa-1 and UltIMMa-2 studies. J Eur Acad Dermatol Venereol 2020; 34:2830-2838. [PMID: 32320088 PMCID: PMC7818271 DOI: 10.1111/jdv.16521] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/31/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Risankizumab is a humanized IgG monoclonal antibody that selectively inhibits interleukin-23 through binding the p19 subunit. In Phase 3 trials, risankizumab demonstrated superior efficacy compared with adalimumab and ustekinumab in patients with moderate-to-severe plaque psoriasis. Here, we evaluated the impact of baseline characteristics on efficacy of risankizumab compared with ustekinumab in patients with moderate-to-severe plaque psoriasis. METHODS This analysis included all patients initially randomized to risankizumab or ustekinumab from the replicate, double-blinded, randomized, placebo-controlled phase 3 trials, UltIMMa-1 (NCT02684370) and UltIMMa-2 (NCT02684357). Patients received either risankizumab (150 mg) or ustekinumab (weight-based; 45 or 90 mg per label) at weeks 0, 4, 16, 28 and 40. Efficacy was assessed as the proportion of patients achieving ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at weeks 16 and 52 by baseline patient demographics, disease characteristics and prior biologic exposure. Mean per cent improvement in PASI was calculated by body weight and body mass index at week 52. Missing efficacy data were imputed as non-responders for categorical variables and last observation carried forward for continuous variables. Logistic regression analyses assessed for interactions between treatment and five independent variables (age, sex, weight, baseline PASI score and presence of psoriatic arthritis) at both weeks 16 and 52. RESULTS Baseline patient demographics, disease characteristics and prior biologic exposure were similar between patients randomized to risankizumab (n = 598) and ustekinumab (n = 199). At weeks 16 and 52, risankizumab demonstrated superior efficacy compared with ustekinumab across these patient characteristics (P < 0.01). Logistic regression analyses demonstrated that risankizumab was superior to ustekinumab at weeks 16 and 52 in all models tested (P < 0.0001 for all). CONCLUSIONS Risankizumab demonstrated consistent and superior efficacy compared with ustekinumab regardless of patient demographics, disease characteristics or prior biologic exposure.
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Affiliation(s)
- B Strober
- Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | - A Menter
- Baylor Scott and White, Dallas, TX, USA
| | - C Leonardi
- Central Dermatology, Richmond Heights, MO, USA
| | - K Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - L Puig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - T Zhan
- AbbVie, Inc., North Chicago, IL, USA
| | - P Foley
- St. Vincent's Hospital Melbourne, Probity Medical Research, Skin Health Institute, The University of Melbourne, Melbourne, VIC, Australia
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13
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Shi L, Lian N, Liu L, Chen M. Tapering and discontinuation of systemic medications in psoriasis patients with low disease activity. Dermatol Ther 2020; 33:e13599. [PMID: 32415804 DOI: 10.1111/dth.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/03/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Psoriasis is a chronic disease and often requires long-term treatment, especially in patients with moderate-to-severe psoriasis. It remains controversial whether the doses of systemic medications could be tapered or if these medications could be discontinued among patients in clinical remission. In this review, we summarize whether it is possible to taper or discontinue methotrexate, cyclosporine, and biologics while controlling the relapse rates of psoriasis. Based on the current evidence, methotrexate and biologics should not be discontinued for psoriasis patients with low disease activity. However, the doses of these medications could be tapered by reducing the maintenance dose or increasing the between-dose intervals. If the disease recurs, methotrexate and biologics should be restarted at their standard doses, and for cyclosporine, the dose can be maintained or discontinued progressively. If patients relapse, cyclosporine can be given again. The decisions to taper or discontinue anti-psoriasis drugs need to account for both benefits and risks and should be individualized according to patients' disease severity, quality of life, and presence of comorbidities.
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Affiliation(s)
- Liqing Shi
- Department of Dermatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, Jiangsu, China
| | - Ni Lian
- Department of Dermatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, Jiangsu, China
| | - Lihao Liu
- Department of Dermatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, Jiangsu, China
| | - Min Chen
- Department of Dermatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, Jiangsu, China
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14
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Di Altobrando A, Magnano M, Offidani A, Parodi A, Patrizi A, Campanati A, Burlando M, Bardazzi F. Deferred time of delivery of biologic therapies in patients with stabilized psoriasis leads to a 'perceived satisfaction': a multicentric study. J DERMATOL TREAT 2020; 33:415-419. [PMID: 32314934 DOI: 10.1080/09546634.2020.1759769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Thanks to their specificity of action, biologic drugs often lead to complete clearance of psoriatic lesions. In order to maintain its effectiveness, biological therapies cannot be discontinued. The aim of the study was to investigate the effect of widening the administration window of four biologic drugs, thus improving the quality of life of psoriatic patients and satisfying their desire to feel free from the disease, without loss of effectiveness.Methods: We performed a multicentric cohort study considering patients with moderate-severe plaque psoriasis and/or arthropathic psoriasis treated with infliximab, adalimumab, etanercept or ustekinumab. The study group included patients with stabilized psoriasis in which the administration regimen of the biologic drug was deferred. The control group included psoriatic patients treated according the product monograph.Results: The percentage of relapses in case of deferred administration intervals was comparable to that of standard administration intervals. The delayed administration modality got a good psychological consensus from the patients themselves, that reported a greater 'perceived satisfaction'. A consistent economic advantage was reported in case of prolonged administration intervals.Conclusions: The administration of biologic drugs with prolonged intervals maintains the same effectiveness as standard administration and produces a 'perceived satisfaction' in psoriatic patients.
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Affiliation(s)
- Ambra Di Altobrando
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Michela Magnano
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences - DISCLIMO, Polytechnic Marche University, Ancona, Italy
| | - Aurora Parodi
- Department of Dermatology, University of Genoa, Italy
| | - Annalisa Patrizi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular Sciences - DISCLIMO, Polytechnic Marche University, Ancona, Italy
| | | | - Federico Bardazzi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
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15
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Ovejero‐Benito M, Muñoz‐Aceituno E, Sabador D, Reolid A, Llamas‐Velasco M, Prieto‐Pérez R, Abad‐Santos F, Daudén E. Polymorphisms associated with optimization of biological therapy through drug dose reduction in moderate‐to‐severe psoriasis. J Eur Acad Dermatol Venereol 2020; 34:e271-e275. [DOI: 10.1111/jdv.16256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M.C. Ovejero‐Benito
- Clinical Pharmacology Department Instituto Teófilo Hernando Facultad de Medicina Hospital Universitario de la Princesa Universidad Autónoma de Madrid (UAM) Madrid Spain
| | - E. Muñoz‐Aceituno
- Dermatology Department Instituto de Investigación Sanitaria La Princesa (IIS‐IP) Hospital Universitario de la Princesa Madrid Spain
| | - D. Sabador
- Clinical Pharmacology Department Instituto Teófilo Hernando Facultad de Medicina Hospital Universitario de la Princesa Universidad Autónoma de Madrid (UAM) Madrid Spain
| | - A. Reolid
- Dermatology Department Instituto de Investigación Sanitaria La Princesa (IIS‐IP) Hospital Universitario de la Princesa Madrid Spain
| | - M. Llamas‐Velasco
- Dermatology Department Instituto de Investigación Sanitaria La Princesa (IIS‐IP) Hospital Universitario de la Princesa Madrid Spain
| | - R. Prieto‐Pérez
- Clinical Pharmacology Department Instituto Teófilo Hernando Facultad de Medicina Hospital Universitario de la Princesa Universidad Autónoma de Madrid (UAM) Madrid Spain
| | - F. Abad‐Santos
- Clinical Pharmacology Department Instituto Teófilo Hernando Facultad de Medicina Hospital Universitario de la Princesa Universidad Autónoma de Madrid (UAM) Madrid Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) Instituto de Salud Carlos III Madrid Spain
| | - E. Daudén
- Dermatology Department Instituto de Investigación Sanitaria La Princesa (IIS‐IP) Hospital Universitario de la Princesa Madrid Spain
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16
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Lio PA. Considerations in Weaning or Withdrawing Dupilumab Therapy-Nothing Is Forever. JAMA Dermatol 2020; 156:119-120. [PMID: 31876915 DOI: 10.1001/jamadermatol.2019.3331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Peter A Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Chicago Integrative Eczema Center, Chicago, Illinois
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17
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Gómez-de Castro C, Mir-Bonafé M, Arias-Martínez A, Martínez-Camblor P, Díaz-Coto S, Santos-Juanes J. Comment on 'Baseline patients' characteristics as predictors for therapeutic survival and response in patients with psoriasis on biological treatments'. Australas J Dermatol 2019; 60:e258-e259. [PMID: 30812057 DOI: 10.1111/ajd.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Marc Mir-Bonafé
- Dermatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Pablo Martínez-Camblor
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA.,Universidad Autónoma de Chile, Santiago, Chile
| | | | - Jorge Santos-Juanes
- Dermatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Departamento de Medicina, Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
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18
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Affiliation(s)
- Mina Amin
- Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Erica B. Lee
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Jashin J. Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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19
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Romero-Jimenez RM, Escudero-Vilaplana V, Baniandres Rodriguez O, García Martín E, Mateos Mayo A, Sanjurjo Saez M. Association between clinical factors and dose modification strategies in the treatment with ustekinumab for moderate-to-severe plaque psoriasis. J DERMATOL TREAT 2018; 29:792-796. [PMID: 29676189 DOI: 10.1080/09546634.2018.1466978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to identify clinical factors associated with dose reduction and dose escalation in the treatment with ustekinumab in patients with moderate-to-severe plaque psoriasis. MATERIALS AND METHODS An observational, longitudinal and retrospective study was conducted using patients with moderate-to-severe plaque psoriasis. We reviewed clinical histories and variables were recorded on a database (patients' characteristics, pharmacotherapeutics, effectiveness and safety). We evaluated correlation between dose reduction, dose escalation and used dose with other variables. RESULTS Of the study's 62 patients, Ustekinumab dose was adjusted in 45.2% (22.6% with reduced doses and 22.6% with increased doses). We found a statistically significant correlation between extending the dosing interval and the absence of psoriatic arthritis, no concomitant systemic therapies, treatment time with ustekinumab, lower PASI at week 28 and achieving PASI75 at week 28. There was also a statistically significant correlation between dose escalation and diabetes mellitus, psoriatic arthritis, prior biological treatments, concomitant systemic therapies, concomitant phototherapy and not achieving PASI75 at week 28. CONCLUSIONS Dose-reduction strategies would increase ustekinumab efficiency in patients that achieve PASI 75 without psoriatic arthritis, diabetes mellitus, previous BT and concomitant treatment with conventional systemic drugs.
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Affiliation(s)
- Rosa M Romero-Jimenez
- a Department of Pharmacy , Hospital General Universitario Gregorio Marañón , Madrid , Spain.,b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain
| | - Vicente Escudero-Vilaplana
- a Department of Pharmacy , Hospital General Universitario Gregorio Marañón , Madrid , Spain.,b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain
| | - Ofelia Baniandres Rodriguez
- b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain.,c Department of Dermatology , Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Estela García Martín
- a Department of Pharmacy , Hospital General Universitario Gregorio Marañón , Madrid , Spain.,b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain
| | - Ana Mateos Mayo
- b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain.,c Department of Dermatology , Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Maria Sanjurjo Saez
- a Department of Pharmacy , Hospital General Universitario Gregorio Marañón , Madrid , Spain.,b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid , Spain
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20
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Lee EB, Thomas LW, Egeberg A, Wu JJ. Dosage adjustments in patients with psoriasis on adalimumab - a retrospective chart review. J Eur Acad Dermatol Venereol 2018; 32:e292-e293. [PMID: 29377299 DOI: 10.1111/jdv.14826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E B Lee
- John A Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, USA
| | - L W Thomas
- School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, USA
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, 1515 North Vermont Ave, 5th floor, Los Angeles, CA, USA
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21
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Carretero G, Puig L, Carrascosa JM, Ferrándiz L, Ruiz-Villaverde R, de la Cueva P, Belinchon I, Vilarrasa E, Del Rio R, Sánchez-Carazo JL, López-Ferrer A, Peral F, Armesto S, Eiris N, Mitxelena J, Vilar-Alejo J, A Martin M, Soria C. Redefining the therapeutic objective in psoriatic patients candidates for biological therapy. J DERMATOL TREAT 2017; 29:334-346. [PMID: 29099667 DOI: 10.1080/09546634.2017.1395794] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The advances in psoriasis management currently allow achieving a good control of the disease. In particular, with the latest developed molecules, available evidence suggests that it is possible to pose an ambitious therapeutic goal, such as a Dermatology Life Quality Index 0/1, a Physician Global Assessment 0/1, or a Psoriasis Area and Severity Index 90/100 response. However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life. To optimize the treatment of psoriasis, it is not enough to define precisely the therapeutic objective, but also to adapt the therapeutic strategy to make the necessary modifications in case of not achieving it at the time point (at the end of the induction phase, or every 3-6 months) to be agreed with the patient (the so-called treat-to-target approach). In the present report, based on the Delphi methodology, 11 dermatologists from the Spanish Psoriasis Group addressed key issues that could be involved in the achievement and maintenance of the therapeutic goals of patients with moderate to severe psoriasis. The document provides 27 consensus statements intended to support clinical decision-making by healthcare professionals for patients who might be candidates to receive biologic therapy.
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Affiliation(s)
- G Carretero
- a Hospital Universitario de Gran Canaria Doctor Negrín , Las Palmas de Gran Canaria , Spain
| | - L Puig
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - J M Carrascosa
- c Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - L Ferrándiz
- d Hospital Universitario Virgen Macarena , Sevilla , Spain
| | | | - P de la Cueva
- f Hospital Universitario Infanta Leonor , Madrid , Spain
| | - I Belinchon
- g Hospital General Universitario de Alicante-ISABIAL , Alicante , Spain
| | - E Vilarrasa
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - R Del Rio
- h Fundació Hospital L'Esperit Sant , Santa Coloma de Gramenet , Spain
| | | | - A López-Ferrer
- b Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - F Peral
- j Hospital Universitario Infanta Cristina de Badajoz , Badajoz , Spain
| | - S Armesto
- k Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - N Eiris
- l Complejo Asistencial Universitario de León , Spain
| | | | - J Vilar-Alejo
- a Hospital Universitario de Gran Canaria Doctor Negrín , Las Palmas de Gran Canaria , Spain
| | - M A Martin
- n Hospital Clínico Universitario Lozano Blesa , Zaragoza , Spain
| | - C Soria
- o Hospital General Universitario Reina Sofia , Murcia , Spain
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22
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Puig L, Notario J, Jiménez-Morales A, Moreno-Ramírez D, López-Ferrer A, Gozalbo I, Prades M, Lizán L, Blanch C. Secukinumab is the most efficient treatment for achieving clear skin in psoriatic patients: a cost-consequence study from the Spanish National Health Service. J DERMATOL TREAT 2017; 28:623-630. [DOI: 10.1080/09546634.2017.1364687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Notario
- Department of Dermatology, Hospital Universitari de Bellvitge, Feixa Llarga, Barcelona, Spain
| | | | - David Moreno-Ramírez
- Medical and Surgical Dermatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Anna López-Ferrer
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Luis Lizán
- Outcomes SL. Castelló de la Plana, Castellón, Spain
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23
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Prolongation of Biologic Dosing Intervals in Patients With Stable Psoriasis: A Feasibility Study. Ther Drug Monit 2017; 39:379-386. [DOI: 10.1097/ftd.0000000000000420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Carrascosa JM, Toro Montecinos M, Ballescá F, Teniente Serra A, Martínez Cáceres E, Ferrándiz C. Correlation between trough serum levels of adalimumab and absolute PASI score in a series of patients with psoriasis. J DERMATOL TREAT 2017; 29:140-144. [DOI: 10.1080/09546634.2017.1341619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- J. M. Carrascosa
- Department of dermatology, Hospital Universitario Germans Trias I pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - M. Toro Montecinos
- Department of dermatology, Hospital Universitario Germans Trias I pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - F. Ballescá
- Department of dermatology, Hospital Universitario Germans Trias I pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - A. Teniente Serra
- Division of Immunology, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Barcelona
- Department of Cellular Biology, Physiology and Immunology, Universidad Autónoma de Barcelona, Badalona, Spain
| | - E. Martínez Cáceres
- Division of Immunology, Germans Trias i Pujol University Hospital and Research Institute, Badalona, Barcelona
- Department of Cellular Biology, Physiology and Immunology, Universidad Autónoma de Barcelona, Badalona, Spain
| | - C. Ferrándiz
- Department of dermatology, Hospital Universitario Germans Trias I pujol, Universidad Autónoma de Barcelona, Badalona, Spain
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25
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Carrascosa JM, Galán M, de Lucas R, Pérez-Ferriols A, Ribera M, Yanguas I. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:712-729. [PMID: 27344068 DOI: 10.1016/j.ad.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. RESULTS Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. CONCLUSIONS The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - M Galán
- Servicio de Dermatología, Hospital de Jaén, Jaén, España
| | - R de Lucas
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - M Ribera
- Servicio de Dermatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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26
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Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Eissing L, Rustenbach S, Krensel M, Zander N, Spehr C, Radtke M, Naldi L, Augustin M. Psoriasis registries worldwide: systematic overview on registry publications. J Eur Acad Dermatol Venereol 2016; 30:1100-6. [DOI: 10.1111/jdv.13634] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - S.J. Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M. Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - C. Spehr
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - L. Naldi
- Practice for Medical Dermatology Bergamo Italy
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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