Drug survival and safety profile of acitretin monotherapy in patients with psoriasis: A multicenter retrospective study

Abstract

Acitretin is a nonimmunosuppresive systemic agent used in the treatment of psoriasis. Despite its frequent use, research on drug survival and adverse effects is limited. This study aims to evaluate drug survival, factors associated with survival, and adverse effects. Database of the six tertiary referral center for psoriasis patients treated with acitretin between November 2014 and April 2020 were retrospectively analyzed. Demographics of patients, adverse effects, and also drug survival were analyzed. Of 412 patients, 61.2% were male, and 38.8% were female. Common clinical adverse effects were cheilitis (71.4%), dry skin (62.5%), and palmoplantar skin peeling (37.2%). High triglyceride and high total cholesterol levels were observed in 50.0% and 49.5% of patients, respectively. Median survival time (95% confidence interval [CI]) was 18 (13.6-22.4) months. Statistically significant risk factors affecting drug discontinuation were having psoriatic arthritis, age under 65, and receiving previous systemic treatment. Drug survival rates were 56.6%, 25.9%, and 19.8% at 1, 5, and 8 years, respectively. Although mucocutaneous adverse effects of the acitretin were quite frequent, severe, life-treatining ones were infrequent. This old, relatively inexpensive and safe treatment remains a good alternative for the treatment of psoriasis.

Survival rates of systemic interventions for psoriasis in the Western Japan Psoriasis Registry: A multicenter retrospective study

“…MTX was not officially labeled for use in patients with psoriasis until 2019 in Japan and is still not frequently used for these cases. ACI has not yet been introduced in Japan, but analyses from other countries show good safety although the survival rate is not high 20–22 . Several reports have analyzed the survival rate of APR, with body weight and related complications suggested as important factors influencing survival in one analysis 23 .…”

“…ACI has not yet been introduced in Japan, but analyses from other countries show good safety although the survival rate is not high. [20][21][22] Several reports have analyzed the survival rate of APR, with body weight and related complications suggested as important factors influencing survival in one analysis. 23 In Japan, APR was released in 2017 and several facilities to date have reported its survival.…”

Impact of Adverse Events Associated With Acitretin Treatment of Moderate-to-Severe Plaque Psoriasis: Based on an Observational, Single-Center Study in Shanghai, China

“…Acitretin is accepted by worldwide experts as an essential systemic treatment for psoriasis. 4,[8][9][10] However, drug reduction or discontinuation is common in clinical practice because of the adverse effects (AEs) related to acitretin. [10][11][12][13][14] Despite this high prevalence of AEs, there is a lack of large-sample studies on the safety of acitretin monotherapy and its effect on patients' quality of life, especially in the Chinese population.…”

Clinical Factors Affecting the Serum Retention of a Teratogenic Etretinate after the Acitretin Administration

“…However, it is not clear how accumulated etretinate and acitretin in adipose tissues can affect the fetus. Although lipophilic etretinate may be released from body fat due to weight loss, similar to other lipophilic agents stored in body fat ( DiGiovanna et al ., 1989 ), no correlation between excess body weight and the rate of etretinate biotransformation has been explained ( Pilkington and Brogden, 1992 ; Maier and Hönigsmann, 2001 ; Kara Polat et al ., 2021 ). Moreover, there are no teratogenic data available for etretinate at blood levels of less than 2 ng/mL.…”

“…However, optimal dosing of acitretin has been proposed previously through a dose-escalation strategy with initiation at low doses (10 to 25 mg/day) due to individual variations in both efficacy and safety ( Ling, 1999 ). Koreans usually take less than one-third dose, such as 10-20 mg/day, to reduce severe dryness of the lips and skin, which is a common acitretin-induced adverse drug reaction ( Pilkington and Brogden, 1992 ; Lee and Koo, 2005 ; Kara Polat et al ., 2021 ). Thus, this study examined several factors that influence the retention of acitretin and etretinate in the body, particularly in the serum.…”