Efficacy and Cost-Efficacy of Biologic Therapies for Moderate to Severe Psoriasis: A Meta-Analysis and Cost-Efficacy Analysis Using the Intention-to-Treat Principle

Chi, Ching‐Chi; Wang, Tzu-Yu

doi:10.1155/2014/862851

Cited by 23 publications

(14 citation statements)

References 25 publications

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“…The included drug survival studies did not consider the costs of treatments. One previous study on the cost-efficacy of biologics for treating psoriasis demonstrates ustekinumab and adalimumab had the lowest 1-year cost per PASI 75 responder, while ustekinumab had the lowest 2-year cost per PASI 75 responder 46 . Clinicians may consider the data on drug survival and cost efficacy in choosing biologics for treating psoriasis to achieve clinical benefit at the least medical expenditure.…”

Section: Discussionmentioning

confidence: 91%

Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence

Lin

Wang

Chi

2018

Sci Rep

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Drug survival of biologics represents their real-world effectiveness and safety. We conducted a meta-analysis of real-world evidence on the drug survival of biologics in treating psoriasis. We searched the PubMed, CENTRAL, and EMBASE databases from inception to 7th October 2017 for studies reporting the annual drug survival for at least 1 year. Two authors independently screened and selected relevant studies, and assessed their risk of bias. A third author was available for arbitrating discrepancies. We conducted a random-effects model meta-analysis to obtain the respective pooled drug survival from year 1 to 4. We conducted subgroup analysis on biologic-naïve subjects, discontinuation for loss of efficacy and adverse effects. We included 37 studies with 32,631 subjects. The drug survival for all biologics decreased with time, dropping from 66% at year 1 to 41% at year 4 for etanercept, from 69% to 47% for adalimumab, from 61% to 42% for infliximab, and from 82% to 56% for ustekinumab. Ustekinumab was associated with the highest drug survival in all and biologic-naïve subjects. Etanercept was associated with the lowest drug survival and was most commonly discontinued for loss of efficacy. Infliximab was most frequently associated with discontinuation for adverse effects. Clinicians may use this study as a reference in treating psoriasis.

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Section: Discussionmentioning

confidence: 91%

Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence

Lin

Wang

Chi

2018

Sci Rep

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“…All studies provided a research question; however, the viewpoint of the analyses was stated clearly in only 77% [ 28 , 29 , 32 – 35 , 37 – 39 , 41 – 52 , 54 – 57 , 59 , 61 , 62 , 64 – 66 , 70 – 76 , 78 – 80 ]. A total of 47 studies reported the source of effectiveness estimates [ 28 – 42 , 48 – 79 ], and in nearly two-thirds of them, further information on methods of synthesis (if based on multiple studies) or design and result (if based on a single study) was provided [ 28 , 30 , 31 , 33 – 36 , 38 , 40 , 48 , 52 , 54 , 55 , 58 – 60 , 63 – 66 , 69 – 74 , 78 , 79 ]. Even though price data was always recorded, only 31 studies reported quantities of resources and unit costs separately [ 28 , 29 , 32 , 34 , 35 , 38 , 40 – 42 , …”

Section: Resultsmentioning

confidence: 99%

“…Ixekizumab was considered in one study. The majority of studies analyzed the economic relationship between the TNF-inhibitors adalimumab, etanercept, and infliximab (n = 32; 60%) [ 28 – 30 , 32 , 34 , 36 , 39 – 41 , 43 – 50 , 56 – 58 , 63 , 64 , 67 – 70 , 72 – 77 ] ( Fig 2B ). In all six studies investigating secukinumab, this medication was compared to ustekinumab ( Fig 2C ).…”

Section: Resultsmentioning

confidence: 99%

“…One of these studies additionally incorporated apremilast [ 32 ] ( Fig 2C ). Most commonly, a Markov model was adapted (40%) [ 28 , 30 , 33 , 35 , 37 , 39 , 51 , 52 , 54 – 59 , 62 , 65 , 70 , 73 , 77 , 78 ], followed by decision trees (20%) [ 34 , 36 , 43 – 49 , 69 ]. The time horizon of data assessment varied between 10 weeks and 20 years.…”

Section: Resultsmentioning

confidence: 99%

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Biologicals and small molecules in psoriasis: A systematic review of economic evaluations

et al. 2018

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Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder’s interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.

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“…Somado a isto, o custo elevado dessa classe de fármacos constitui outro fator limitante de adesão ao tratamento, particularmente nos países em desenvolvimento (Chi, Wang, 2014;Diamantino, Ferreira, 2012).…”

Section: Psoríase E Tratamentos Farmacológicosunclassified

Avaliação farmacológica de uma nanodispersão contendo GYY4137 (doador de liberação lenta de H<sub>2</sub>S) na psoríase experimental.

Schmidt¹

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Psoriasis is a chronic inflammatory disease, immune-mediated, with a high world incidence, whose skin lesions and intense itching, reduce markedly the life quality of patients. Previously, the group has shown that systemic treatment with the slow release donor of hydrogen sulfide (H 2 S), GYY4137, significantly inhibited skin inflammation and itching in a experimental model of psoriasis induced by imiquimod (IMQ). In order to further this knowledge, the aims of this study were: i) to develop and characterize topical formulations (four microemulsion and one nanodispersion), as a vehicle for GYY4137; ii) to evaluate the therapeutic effect of the selected formulation on the itching behaviour, inflammation and Psoriasis Area Severity Index (PASI) in mice BALB/c iii) to evaluate differences in H 2 S generation in animal skin with psoriasis and iv) ascertain comparatively the pharmacological effect and toxicological potential of the selected formulation containing 4% GYY4137 in relation to the same formulation containing dexamethasone. Amongst the developed formulation, the nanodispersion proved to be less irritating in murine skin, since neither inflammation nor skin rash was observed in animals, unlike the other four preparations. The daily topical application of IMQ cream (5%; 65 mg; Germed, Brazil) in the mice shaved dorsal skin and ear surface, for five consecutive days, promoted itching as well as signs and symptoms consistent with the signs and symptoms of psoriasis (PASI) compared to the control group, which received the vehicle (Vaseline). Control or animals with psoriasis were treated daily once or twice with a nanodispersion (65 mg) containing GYY4137, dexamethasone or vehicle. PASI and pruritus were measured daily while the concentration of inflammatory cytokines (IL-6 and IL-1β), peripheral leukocytes, spleen, splenomegaly, myeloperoxidase activity (MPO) and other inflammatory markers were measured on the last (6 th) day. The therapy with one or two daily doses of nanodispersion containing 4% GYY4137 showed that two daily doses showed to be (P <0.05) more effective in reducing the inflammatory parameters and PASI, but only reduced, in a not significant manner, the itching behaviour. Animal with psoriasis also showed a reduction in H 2 S skin generation, wich was partially reversed by GYY4137 (4%, 2x/day) treatment. Regarding the formulation containing dexamethasone, it should be noted that the pharmacological effects were statistically similar to those obtained with 4% GYY4137, except that the effects produced by the latter was safer since neither systemic effects nor toxicological potential were observed. In conclusion, the treatment with the nanodispersion containing 4% GYY4137 exhibited safer therapeutic potential for reducing signs and symptoms associated with psoriasis.

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Efficacy and Cost-Efficacy of Biologic Therapies for Moderate to Severe Psoriasis: A Meta-Analysis and Cost-Efficacy Analysis Using the Intention-to-Treat Principle

Cited by 23 publications

References 25 publications

Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence

Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence

Biologicals and small molecules in psoriasis: A systematic review of economic evaluations

Avaliação farmacológica de uma nanodispersão contendo GYY4137 (doador de liberação lenta de H<sub>2</sub>S) na psoríase experimental.

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