Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:71

Article

Takeshita, Junko^1,2  Wang, Shuwei³  Shin, Daniel B.^1,2  Duffin, Kristina Callis⁴  Krueger, Gerald G.⁴  Kalb, Robert E.⁵  Weisman, Jamie D.⁶  Sperber, Brian R.⁷  Stierstorfer, Michael B.⁸  Brod, Bruce A.⁹  Schleicher, Stephen M.¹⁰  Robertson, Andrew D.¹¹  Linn, Kristin A.²  Shinohara, Russell T.²  Troxel, Andrea B.²  Van Voorhees, Abby S.¹  Gelfand, Joel M.^1,2 

[1] Univ Penn, Perelman Sch Med, Dept Dermatol, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostat, Dept Epidemiol & Biostat, Philadelphia, PA 19104 USA

[3] Thomas Jefferson Univ, Philadelphia, PA 19107 USA

[4] Univ Utah, Sch Med, Dept Dermatol, Salt Lake City, UT 84112 USA

[5] SUNY Buffalo, Sch Med & Biomed Sci, Dept Dermatol, Buffalo, NY 14260 USA

[6] Peachtree Dermatol Associates, Atlanta, GA USA

[7] Colorado Springs Dermatol Clin, Colorado Springs, CO USA

[8] East Penn Dermatol, N Wales, PA USA

[9] Dermatol Associates Lancaster, Lancaster, PA USA

[10] DermDox Ctr Dermatol, Hazleton, PA USA

[11] Natl Psoriasis Fdn, Portland, OR USA

关键词: biologics;    combination therapy;    comparative effectiveness;    Dermatology Life Quality Index;    Physician Global Assessment;    psoriasis;    quality of life;    systemic treatments;   

DOI  :  10.1016/j.jaad.2014.08.003

来源: Elsevier

【 摘 要 】

Background: The effectiveness of psoriasis therapies in real-world settings remains relatively unknown. Objective: We sought to compare the effectiveness of less commonly used systemic therapies and commonly used combination therapies for psoriasis. Methods: This was a multicenter cross-sectional study of 203 patients with plaque psoriasis receiving less common systemic monotherapy (acitretin, cyclosporine, or infliximab) or common combination therapies (adalimumab, etanercept, or infliximab and methotrexate) compared with 168 patients receiving methotrexate evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network. Results: In adjusted analyses, patients on acitretin (relative response rate 2.01; 95% confidence interval [CI] 1.18-3.41), infliximab (relative response rate 1.93; 95% CI 1.26-2.98), adalimumab and methotrexate (relative response rate 3.04; 95% CI 2.12-4.36), etanercept and methotrexate (relative response rate 2.22; 95% CI 1.25-3.94), and infliximab and methotrexate (relative response rate 1.72; 95% CI 1.10-2.70) were more likely to have clear or almost clear skin compared with patients on methotrexate. There were no differences among treatments when response rate was defined by health-related quality of life. Limitations: Single time point assessment may result in overestimation of effectiveness. Conclusions: The efficacy of therapies in clinical trials may overestimate their effectiveness as used in clinical practice. Although physician-reported relative response rates were different among therapies, absolute differences were small and did not correspond to differences in patient-reported outcomes.

【 授权许可】

Free