Effectiveness of sequential use of biologics in the treatment of moderate to severe psoriasis in real world Canadian academic clinical practice: A cohort study

Qiang, Judy; Shahbaz, Ali; Whan, Kim Tae; Marinas, Joseph E.C.; Greaves, Simón; Yeung, Jensen

doi:10.1016/j.jaad.2015.08.030

Cited by 5 publications

(8 citation statements)

References 6 publications

(9 reference statements)

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“…demonstrated that patients with two previously failed biologics were half as likely to respond to the present treatment compared with subjects with just one failed biologic (OR = 0.474; 95% confidence interval [CI] 0.23–0.96; p = 0.04). 38 However, Clemmensen et al . found no difference in the PASI 75 response to UST between the subjects exposed to one, two, or three TNFi.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of secukinumab for psoriasis in real-world practice: analysis of subgroups stratified by prior biologic failure or reimbursement

Ger

Huang

Hui

et al. 2019

Therapeutic Advances in Chronic Disease

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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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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of secukinumab for psoriasis in real-world practice: analysis of subgroups stratified by prior biologic failure or reimbursement

Ger

Huang

Hui

et al. 2019

Therapeutic Advances in Chronic Disease

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“…Nine studies assessed third‐ and later line biologic or targeted small molecules 21–23,32–36,39 . Four of the studies found a reduction in effectiveness in third‐ or fourth‐line, compared to first‐ or second‐line 23,33,36,39 .…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of sequential lines of biologic and targeted small molecule drugs in psoriasis: A systematic review and meta‐analysis

Gollins,

Vincent,

Fahy

et al. 2024

Skin Health and Disease

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To assess current evidence of effectiveness of sequential lines of biologic and targeted small molecule drugs for psoriasis beyond first line. A systematic search of the literature (Medline, Embase and bibliographic) was undertaken in October and December 2022 to find all studies assessing effectiveness of biologics and targeted small molecules when used beyond first‐line in adults with psoriasis (PROSPERO CRD42022365298). Data extraction and a bias assessment (Risk Of Bias In Non‐randomized Studies—of Interventions/Cochrane RoB2) were undertaken for all included studies. A random effects proportional meta‐analysis was undertaken for PASI75/90/100 at 12–16 weeks for each line of treatment (1st to 4th). Of 2666 abstracts identified, a full text review was undertaken of 177 studies; 20 manuscripts met eligibility criteria. Twenty studies were included in the analysis: 19 observational studies and one sub analysis of a RCT; n = 6495 (average age 49.7 years, female 35.1%). Eleven studies assessed second line biologic, nine assessed third + line. A meta‐analysis of PASI75 at 12–16 weeks found pooled effect percentage achieving PASI75 of 61%, 56%, 79% and 61% in 1st, 2nd, 3rd and 4th line biologics respectively. Meta‐analyses of PASI90/100 also found no evidence of diminished effectiveness with sequential lines (PASI90 46.1%, 39.9%, 55.8% and 33.7% and PASI100 36.7%, 30.3%, 46.7% and 30.4% in 1st to 4th line respectively). Available evidence for effectiveness of biologics beyond first line in psoriasis is predominantly observational, at high risk of bias and of low quality. There is very limited data for effectiveness beyond second line. Evidence indicates that biologics can be effective to fourth‐line.

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“…The lack of response to one biologic does not preclude the response to another biologic. For example, of 65 patients who had failed antieTNF-a therapy, 72% achieved significant improvement, defined as PASI 75, after 12 weeks of ustekinumab (Qiang et al, 2016).…”

Section: Discussion Of Incorrect Answersmentioning

confidence: 99%

SnapshotDx Quiz: August 2021

Glaser

Miteva

2021

Journal of Investigative Dermatology

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Patients with psoriasis have a decreased incidence of type 2 diabetes mellitus when controlling for body mass index, smoking, cardiovascular disease, hypertension, and hyperlipidemia. b. Immune cells infiltrating the psoriatic skin secrete high amounts of proinflammatory cytokines IL-17, TNF-a, IL-21, and IL-36.c. The primary effects of IL-17 on keratinocytes (KCs) include direct induction of epidermal hyperplasia.d. Inhibition of one cytokine is sufficient to achieve disease resolution in essentially all patients with psoriasis.e. The efficacy of TNF antagonists in patients with psoriasis is unrelated to their effects on IL-23/T helper type 17 cell signaling. 3. Which of the following answers is FALSE according to the article by Zeng et al. (2021)? a. IL-33 is increased in the lesional skin of patients with psoriasis. b. IL33 mRNA expression decreased in the lesional psoriatic skin after treatment with antieIL-17 receptor antibody. c. Intradermal injection of IL-33 alone failed to induce psoriatic-like dermatitis. d. KCs are the major cells producing IL-33 in the skin.e. In addition to NF-kB, IL-33 induces Jak2/signal transducer and activator of transcription 3 axis activation in the KCs.

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Effectiveness of sequential use of biologics in the treatment of moderate to severe psoriasis in real world Canadian academic clinical practice: A cohort study

Cited by 5 publications

References 6 publications

Effectiveness and safety of secukinumab for psoriasis in real-world practice: analysis of subgroups stratified by prior biologic failure or reimbursement

Effectiveness and safety of secukinumab for psoriasis in real-world practice: analysis of subgroups stratified by prior biologic failure or reimbursement

Effectiveness of sequential lines of biologic and targeted small molecule drugs in psoriasis: A systematic review and meta‐analysis

SnapshotDx Quiz: August 2021

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