Persistency of Biologic Therapies for Plaque Psoriasis in 2 Large Community Practices

Verma, Luvneet; Mayba, Julia; Gooderham, Melinda; Verma, Abhinav; Papp, Kim

doi:10.1177/1203475417733957

Cited by 9 publications

(27 citation statements)

References 15 publications

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Section: Resultsmentioning

confidence: 99%

“…We also wanted to interpret the influence of the predictors (female sex, obesity, psoriatic arthritis) regardless of the choice of biologic. Female sex consistently predicted biologic discontinuation in the included studies for the biologics combined group, 15,17,18,[31][32][33][34] adalimumab alone 34,41 and etanercept alone (Fig. 2).…”

Section: Discussionmentioning

confidence: 94%

“…To assess possible sources of heterogeneity, studies were removed one by one and the analyses were repeated. For female sex due to overall effect (combined biologics group), the HR was 1.34 (95% CI 1.29-1.38) and the I 2 -value was 0% after the study by Verma et al 32 was removed. In the meta-analysis for obesity due to ineffectiveness (combined biologics group), the study by Carrascosa and Notario 39 was removed from the analysis and this did not change the significance of the pooled result.…”

Section: Sensitivity Analysismentioning

confidence: 96%

“…The predictive factors analysed in at least two studies were meta-analysed, leading to the inclusion of female sex, obesity and psoriatic arthritis in the pooled analysis. In total 13 cohort studies were included in the meta-analysis (n = 29 802): nine for female sex (n = 28 090), 15,17,18,[31][32][33][34][35][36] six for obesity (n = 9311) 15,17,31,[35][36][37] and six for psoriatic arthritis (n = 24 444) ( Fig. 1 and Tables S1 and S2; see Supporting Information).…”

Section: Study Selectionmentioning

confidence: 99%

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Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

et al. 2019

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Summary Background Long‐term therapy for psoriasis is impaired by gradual loss of effectiveness and treatment discontinuation. Identifying factors that affect biologic drug survival may help in treatment optimization. Objectives To identify factors that predicted biologic drug persistence or discontinuation in a real‐life setting. Methods We identified studies of biologic persistence in psoriasis through a comprehensive, systematic literature search using predefined search criteria. Studies were screened by title and abstract then further by full‐text review. Hazard ratio (HR) data were extracted for all available predictive factors (HRs > 1 denoted biologic discontinuation, and HRs < 1 denoted biologic persistence). A meta‐analysis of HRs (random‐effects model) was used to assess any predictive factor included in at least two studies. Results Sixteen cohort studies were included in the review, with a total of 32 194 patients. A meta‐analysis was performed on 13 studies (n = 29 802): nine for female sex (n = 28 090), six for obesity (n = 9311) and six for psoriatic arthritis (n = 24 444). Obesity and female sex predicted treatment discontinuation, with HRs of 1.21 [95% confidence interval (CI) 1.10–1.32, I2 = 0%] and 1.22 (95% CI 1.07–1.38, I2 = 84%), respectively. Concomitant psoriatic arthritis predicted biologic persistence (HR 0.83, 95% CI 0.80–0.86, I2 = 0%). Female sex predicted biologic discontinuation due to side‐effects, with a pooled HR of 2.16 (95% CI 1.39–3.35, I2 = 67%). Other reported predictive factors (smoking, metabolic syndrome, biologic naivety, age, Dermatology Life Quality Index, dyslipidaemia, high socioeconomic status and concomitant methotrexate) were insufficiently reported for meta‐analysis. Conclusions Our meta‐analysis demonstrates that female sex and obesity predict biologic discontinuation, and concomitant psoriatic arthritis predicts biologic survival. What's already known about this topic? Ineffectiveness is the main factor that causes drug discontinuation during long‐term treatment of psoriasis. It is unclear which factors and comorbidities impact drug persistence. What does this study add? Female sex and obesity predict biologic discontinuation due to ineffectiveness and adverse events. Concomitant psoriatic arthritis is associated with improved drug persistence.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 94%

Section: Sensitivity Analysismentioning

confidence: 96%

Section: Study Selectionmentioning

confidence: 99%

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Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

et al. 2019

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“…Psoriasis is one of the most serious autoimmune diseases with numerous of obvious pathological changes in the lesional skin, including epidermal abnormal proliferation, aberrant differentiation and so on, and these events would induce erythematous plaques on the patient's skin, which is itchy and even very painful . Due to the complex pathogenesis of psoriasis, there are very few effective treatments for the patients of psoriasis . Traditionally, various topical therapies can be used to treat the patients with mild disease of psoriasis, such as topical retinoids, corticosteroids, vitamin D and its analogues .…”

Section: Discussionmentioning

confidence: 99%

Rapamycin ameliorates psoriasis by regulating the expression and methylation levels of tropomyosin viaERK1/2 andmTORpathways in vitro and in vivo

Gao

2018

Experimental Dermatology

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Psoriasis is a chronic inflammatory disease, affecting more than millions of people in the world. Recently, the mTOR inhibitor rapamycin (RAPA) was reported to be involved in the pathogenesis of psoriasis. However, the underlying mechanism remains unclear. Haematoxylin and eosin staining was used to examine the effects of RAPA on inflammatory level of lesional tissues from patients with psoriasis and animal models. Quantitative real-time PCR, immunohistochemistry and western blot assay were performed to assess the effects of RAPA on tropomyosins (TPMs) expression in patients with psoriasis, cell models and animal models. Phalloidin staining was used to assess the RAPA effects on cell skeleton. The effects of RAPA on cell proliferation and cell cycle were detected by CCK-8 assay, EdU staining and flow cytometry. Methylation status of TPMs was analysed by methylation-specific PCR. The expression of TPM1 and TPM2 was significantly downregulated, while their methylation level was obviously higher in the lesional tissues, cell models and animal models of psoriasis. After treated with RAPA, the expression and methylation levels of TPMs were all restored in the cell models and animal models of psoriasis. RAPA inhibited cell proliferation and decreased the ratio of S phase cell in Hacat or human epidermal keratinocytes cell models of psoriasis. Finally, the activated ERK1/2 and mTOR pathways in the cell model and animal model of psoriasis were suppressed by the treatment of RAPA. RAPA could be used as an effective agent for the treatment of psoriasis by decreasing the methylation level of TPM1 and TPM2 via inhibiting the ERK1/2 and mTOR signalling pathways.

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Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic Apulian registry (BIOPURE)

Iannone

Santo²,

Bucci

et al. 2018

Clin Rheumatol

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This study aims to evaluate the drug survival and effectiveness of ustekinumab in psoriatic arthritis (PsA) patients naïve to biologics or inadequate responders to tumor necrosis factor (TNF-IR) inhibitors in real life. PsA patients starting ustekinumab were enrolled from 2014 to 2016. Joint involvement, peripheral or axial, Psoriatic Area Severity Index, Disease Activity Psoriatic Arthritis (DAPSA), Lee Enthesitis Index, Health Assessment Questionnaire, body mass index, comorbidities, co-therapies, mechanism of action, and causes of discontinuation of prior TNFi were collected at baseline, and 6 and 12 months. Twelve-month drug survival was evaluated by Kaplan-Meier curves. Hazard ratios (HRs) of drug discontinuation adjusted for baseline factors were estimated by multiple Cox regression analysis. Percentages of DAPSA-based remission, as crude value and adjusted for drug retention (LUNDEX index), were compared by χ test. Mean differences of DAPSA from baseline to 6 and 12 months were compared between naïve and TNF-IR patients by ANOVA. Of 160 PsA patients starting ustekinumab, 54 were naïve and 106 were TNF-IR. Twelve-month drug survival was significantly higher in naïve (87%) than in TNF-IR (68%, p = 0.01). Baseline co-therapy with methotrexate did not increase the persistence on ustekinumab. Naïve patients had the lowest risk of ustekinumab discontinuation (HR 0.27, p = 0.01), and the highest DAPSA-based remission (34%, LUNDEX 26%). Mean differences from baseline of DAPSA was significantly greater in naïve than in TNF-IR patients at 12 months (- 14.4 ± 10 vs. - 4.1 ± 17, p = 0.01). Our data showed that ustekinumab has a good effectiveness in real life and the best outcomes are achieved in biologic-naïve PsA patients.

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Persistency of Biologic Therapies for Plaque Psoriasis in 2 Large Community Practices

Abstract: UST has a higher drug survival rate than ADA, ETA, and IFX, as observed in other studies. When practice patterns are compared, dosage difference is the main factor that may cause differing survival rates.

Cited by 9 publications

References 15 publications

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

Rapamycin ameliorates psoriasis by regulating the expression and methylation levels of tropomyosin viaERK1/2 andmTORpathways in vitro and in vivo

Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic Apulian registry (BIOPURE)

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