Duracion del tratamiento de la psoriasis con biologicos...
ORBIT (Outcome and Retention Rate of Biologic Treatments for Psoriasis): A Retrospective Observational Study on Biologic Drug Survival in Daily Practice
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Biologic drug survival was evaluated in 427 patients with psoriasis, including a total of 703 treatment courses, in this retrospective observational study. Median drug survival was 31 months. Drug survival was lower in obese patients compared with patients with BMI <30 (23 months vs 37.3 months, respectively). In multivariate analysis the authors found that ustekinumab treatment and PASI75 and PASI90 responses at week 16 were significantly associated with increased drug survival whereas obesity, etanercept treatment, and strict adherence to SmPC doses were associated with lower drug survival. Dose augmentation and combination treatment did not significantly affect drug survival, except for dose augmentation of infliximab, which was associated with increased drug survival.
Patients with psoriasis treated with ustekinumab and those who achieved a significant improvement were more likely to remain on their biologic medications.
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Adherence to Biologics
Making the diagnosis of psoriasis is not difficult for dermatologists. Now that we have biologic treatments, finding an effective treatment for even horrific psoriasis is not difficult, either. But a key issue we now face is how long that biologic treatment will last. Patients may do well on biologic treatment for a time, but too often the great results don't last.
The Outcome and Retention Rate of Biologic Treatments for Psoriasis (ORBIT) study gives us some quantitative information on how long patients persist on treatment.1 After about 2 to 3 years, half of the patients on a biologic stop that particular treatment. Obese patients tended to come off faster, although that finding was not observed in a much larger trial, PSOLAR,2 which also looked at treatment persistence. In both studies, patients on ustekinumab stayed on treatment longer than on TNF inhibitors.
Why do people stop treatment? Mostly it is because either the drug stopped working or because it never worked in the first place. Adverse events are a much less common reason for patients to stop a biologic treatment.
What can we do about poor persistence? First, making sure that patients take their medication regularly may help. Second, giving a biologic with methotrexate potentially could reduce formation of antibodies that reduce a biologic's effectiveness. Finally, and perhaps most importantly, we ought to feel comfortable with all of the available options because there's a very good chance that even if we get patients well with one biologic, someday they may need another.
References
- Vilarrasa E, Notario J, Bordas X, et al. ORBIT (Outcome and Retention Rate of Biologic Treatments for Psoriasis): A retrospective observational study on biologic drug survival in daily practice [published online March 19, 2016]. J Am Acad Dermatol. DOI: http://dx.doi.org/10.1016/j.jaad.2016.01.037b.
- Menter A, Papp KA, Gooderham M, et al. Drug survival of biologic therapy in a large, disease-based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) [published online March 30, 2016]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.13611.
Abstract
BACKGROUND
Biologic drug survival in psoriasis reflects long-term performance in real-life settings. Previous studies have yielded inconsistent results.
OBJECTIVES
We sought to analyze long-term biologic survival and its associated variables in a large, real-life cohort of patients with moderate to severe chronic plaque psoriasis.
METHODS
This was an observational retrospective study. Data were extracted from clinical records of 427 patients treated with biologic agents over a 4-year period. Drug survival was analyzed using the Kaplan-Meier method and the influence of several covariates was assessed using Cox regression.
RESULTS
We analyzed 703 treatment courses. Overall median drug survival was 31.0 months. Cumulative probability of drug survival was lower in obese patients (23.0 months, 95% confidence interval 17.4-28.6) than in patients with body mass index less than 30 (37.3 months, 95% confidence interval 29.4-45.1, P = .001), and it was significantly higher for ustekinumab than for any other biologic agent (log rank test P < .001). Multivariate analysis showed that obesity, etanercept treatment, and strict adherence to approved doses were associated with an increased probability of drug withdrawal, whereas ustekinumab treatment, and PASI75 and PASI90 responses at week 16 prolonged drug survival.
LIMITATIONS
Data were collected retrospectively.
CONCLUSIONS
These findings can facilitate the daily treatment of psoriatic patients and promote long-term effectiveness of biologic therapies.
ORBIT (Outcome and Retention Rate of Biologic Treatments for Psoriasis): A Retrospective Observational Study on Biologic Drug Survival in Daily Practice
J Am Acad Dermatol 2016 Mar 19;[EPub Ahead of Print], E Vilarrasa, J Notario, X Bordas, A López-Ferrer, IJ Gich, L PuigBenjamin Hidalgo-Matlock
posted by dermatica at
April 21, 2016
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