Experience with biologics for psoriasis in daily practice: Rotational therapy is required

Saccomani, Clarisse; Penz, S.; Guerre-Schmidt, R.; Pelletier, F.; Puzenat, E.; Riou-Gotta, Marie-Odile; Humbert, Philippe; Aubin, F.

doi:10.3109/09546630903559806

Cited by 3 publications

(6 citation statements)

References 6 publications

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“…The introduction of biologic agents has made an important contribution to the therapeutic arsenal for treating psoriasis over the past decade. Nevertheless, not all patients respond well to their first biologic agent and thus need to be treated with another biologic agent [1, 2]. It is known that up to one-third of patients discontinue therapy with their first biologic within the first year of treatment [3], so it has become common in clinical practice to switch biologic agents in order to achieve an improved clinical goal in patients with psoriasis [4].…”

Section: Introductionmentioning

confidence: 99%

Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Özkur¹,

Altunay²,

Topal³

et al. 2019

Dermatology

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Background/Objective: The purpose of our study was to provide evidence on the treatment choices, reasons, and results of switching between biologic agents in treating patients with psoriasis. Methods: We conducted a retrospective database search of six tertiary referral centers for psoriasis patients between January 2007 and May 2019. We analyzed patient and treatment characteristics of all patients in the registry. Results: We enrolled 427 psoriatic patients treated with biologics, and 145 (34%) required a switch to another biologic. The reasons for discontinuing the first biologic agent were inefficacy (n = 106, 62.4%), adverse events (n = 28, 16.5%), and others (n = 36, 21.2%). At week 12, there was a 67.7% reduction in the Psoriasis Area and Severity Index (PASI) score of patients treated with their first biologic, and 51.4% reduction for the second. A drug survival analysis showed no statistically significant difference between the drug survival of first-line biologic agents, but ustekinumab had the highest survival rate among second-line biologics (log-rank p = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274–2.782, p = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534–3.552, p < 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 –3.780, p = 0.001) are predictors for discontinuation. Conclusion: Discontinuation of treatment was most commonly due to inefficacy. Patients who switched to a different biologic agent showed a similar improvement in PASI scores compared to biologic-naive patients. Switching to a second biologic therapy due to inefficacy or adverse events caused by the first one may improve psoriasis.

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Section: Introductionmentioning

confidence: 99%

Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Özkur¹,

Altunay²,

Topal³

et al. 2019

Dermatology

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“…Indeed in reviewing their practice with biologics for psoriasis, Saccomani et al. 12 found switching to be effective in most of their patients, with the exception of those switching to efalizumab; there were also two nonresponders. Forty‐six per cent of their 80 patients had required switches between biologics.…”

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confidence: 99%

“…Forty‐six per cent of their 80 patients had required switches between biologics. However, adalimumab was not used in their practice 12 . The Amsterdam group summarized their experience of various switches in biologic therapy, including switches between anti‐TNF agents, and concluded that failure of one agent does not predict failure of another; switching to efalizumab was an exception but is no longer a consideration 13 …”

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confidence: 99%

“…However, the results may be less good than with first-time therapy so this will be slightly less cost-effective. Doubling the dose of adalimumab may be more effective, but financial restraints and limited safety data are likely to lead to a rotational approach 12 with increasing numbers of biologics becoming available. Indeed in reviewing their practice with biologics for psoriasis, Saccomani et al 12 found switching to be effective in most of their patients, with the exception of those switching to efalizumab; there were also two nonresponders.…”

mentioning

confidence: 99%

“…However, adalimumab was not used in their practice. 12 The Amsterdam group summarized their experience of various switches in biologic therapy, including switches between anti-TNF agents, and concluded that failure of one agent does not predict failure of another; switching to efalizumab was an exception but is no longer a consideration. 13 Owing to the poorly understood differences in how individual patients respond to drugs, switching from etanercept to adalimumab because adalimumab appears to be more effective, is not always successful.…”

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confidence: 99%

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Switching biologics for psoriasis

Ormerod

2010

British Journal of Dermatology

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Health Care Utilization and Cost Associated with Biologic Treatment Patterns Among Patients with Moderate to Severe Psoriasis: Analyses from a Large U.S. Claims Database

Feldman

Tian

Wang

et al. 2019

JMCP

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BACKGROUND: Discontinuation or switching of biologic treatment among patients with psoriasis imposes a great economic burden. OBJECTIVE: To assess the health care utilization and costs associated with nonswitchers, switchers, and discontinuers of biologics among patients with moderate to severe psoriasis. METHODS: Patients aged ≥ 18 years with ≥ 1 pharmacy claim for a biologic (adalimumab, etanercept, infliximab, and ustekinumab) between January 1, 2012, and June 30, 2015 (identification period), were identified in the Truven Health Analytics MarketScan Commercial and Medicare Supplemental databases. At the time of biologic initiation (index date), eligible patients were continuously enrolled with medical and pharmacy claims for ≥ 1 year before (baseline period) and ≥1 year after the index date (follow-up period). Patients had ≥1 psoriasis diagnosis and had no pharmacy claims for the index biologic during the baseline period. Patients were categorized into 3 mutually exclusive groups based on their biologic treatment pattern during the 1-year follow-up period: nonswitchers (patients who remained on their index biologic), switchers (patients who had a prescription for a biologic therapy other than their index biologic), and discontinuers (patients who had gaps in prescription claims [> 90 days for adalimumab, infliximab, and etanercept; > 120 days for ustekinumab]). Descriptive analyses were used to summarize baseline patient demographics, clinical characteristics, resource utilization, and health care costs (inflated to 2016 costs) across the 3 groups. Adjusted health care resource utilization and costs during the 1-year follow-up were estimated, controlling for age, sex, geographic region, insurance plan type, index drug, index year, Charlson Comorbidity Index score, resource utilization, total health care costs, and nonbiologic medications during the baseline period. What this study addseffects of discontinuing or switching biologic therapies in patients with psoriasis in clinical practice and may inform treatment and/or formulary decision making.

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Experience with biologics for psoriasis in daily practice: Rotational therapy is required

Cited by 3 publications

References 6 publications

Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Switching biologics for psoriasis

Health Care Utilization and Cost Associated with Biologic Treatment Patterns Among Patients with Moderate to Severe Psoriasis: Analyses from a Large U.S. Claims Database

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