Factors Associated with Drug Survival of Methotrexate and Acitretin in Patients with Psoriasis

Shalom, Guy; Zisman, Devy; Harman-Boehm, Ilana; Biterman, Haim; Greenberg-Dotan, Sari; Polishchuk, Ilya; Moser, Hadas; Freud, Tamar; Feldhamer, Ilan; Cohen, Arnon D

doi:10.2340/00015555-2130

Cited by 29 publications

(61 citation statements)

References 31 publications

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“…The median drug survival was 1·8 years and 15% of patients remained on methotrexate after 5 years . This is similar to the previously published studies on this subject . The majority of patients discontinued methotrexate due to side‐effects.…”

supporting

confidence: 87%

Drug survival of methotrexate in psoriasis

Kirby

2017

Br J Dermatol

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supporting

confidence: 87%

Drug survival of methotrexate in psoriasis

Kirby

2017

Br J Dermatol

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“…The studies conducted by Shalom et al . ( n = 3,624; Israel), Arnold et al . ( n = 63; Switzerland), and Dávila‐Seijo et al .…”

Section: Discussionmentioning

confidence: 99%

“…Drug survival, which usually correlates well with drug adherence, is another topic of interest in psoriasis as it can reflect its cost‐effectiveness . Drug adherence is the extent to which patients take medications as prescribed, whereas drug survival indicates the length of time a certain drug is in use until its cessation . Data regarding the drug survival of acitretin in psoriasis are summarized in Table .…”

Section: Discussionmentioning

confidence: 99%

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Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

et al. 2018

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Background This retrospective observational study aimed to investigate the long‐term safety, drug survival, and factors associated with the survival of acitretin in a real‐world setting. Methods Data of adult patients with psoriasis who attended Siriraj Hospital between 2012 and 2017 and were treated with acitretin were reviewed. Demographic data and clinical courses were recorded. The Kaplan–Meier curve and Cox regression were used to calculate drug survival and the factors associated with drug survival, respectively. Results Of 104 patients, 56 and 48 were male and female, respectively, with a mean treatment duration of 3.2 years. The mean cumulative dose per patient was 19.28 ± 7.84 mg/day. Acitretin was administered to 73, 39, 24, and six patients for more than 1, 3, 5, and 10 years, respectively. Most side effects were mild and tolerable; only nine patients withdrew acitretin due to side effects. No patients developed clinical features of cirrhosis or uncontrolled hyperlipidemia. The drug survival rates were 79%, 69.5%, 61.2%, 57.6%, and 53.5% at 1, 2, 3, 4, and 5 years, respectively, higher than those of previous studies. Patients without obesity, metabolic syndrome, and dyslipidemia did not have a significantly longer acitretin survival compared to patients with these comorbidities. Conclusions Long‐term, low‐dose acitretin in patients with psoriasis is unlikely to cause significant liver or lipid problems. In countries with difficulty accessing biological agents for psoriasis, acitretin may have a high drug survival rate due to its long‐term safety. This study has several limitations: its retrospective nature, single‐center study design, and small sample size.

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“…There are few studies on factors associated with drug survival of conventional systemic treatment. It has been shown that comorbidities are a predictor for discontinuation of treatment and that lack of folic acid supplementation in patients treated with methotrexate is associated with treatment dropout [13] .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Survival of Systemic Psoriasis Treatments: An Analysis of the Swiss Registry SDNTT

et al. 2016

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Background: The Swiss psoriasis registry SDNTT (Swiss Dermatology Network for Targeted Therapies) records the long-term safety and effectiveness of systemic treatment regimens for psoriasis. Patients and Methods: Patients with moderate to severe psoriasis are included in the SDNTT when treatment with a conventional systemic agent or biologic is initiated that was not previously used by the respective patient. Patients are followed over a 5-year period. Clinical data are obtained every 3-6 months using standardized case report forms. Here, baseline data and follow-up data for 1 year of patients included from October 2011 until December 2014 were analyzed. Results: Within 39 months, 323 patients from 7 tertiary dermatology centers in Switzerland were recruited in the SDNTT; 165 patients received biologics and 158 conventional systemic therapies. Patients treated with biologics had a significantly higher severity (PASI 11.3 vs. 9.2, BSA 15.6 vs.11.9, psoriatic arthritis 36.4 vs. 10.8%; p ≤ 0.005, p ≤ 0.013, p ≤ 0.001) and a longer duration of illness (19.2 vs. 14.4 years, p ≤ 0.003) compared to patients starting a conventional systemic treatment. PASI reduction was satisfying in both treatment groups, with 60.6% of patients treated with biologics achieving PASI75 after 1 year compared to 54.2% of patients receiving conventional systemic drugs (nonsignificant). On average, the drug survival in patients receiving a biologic therapy was significantly longer than those receiving conventional systemic treatments (30.5 vs. 19.2 months, p ≤ 0.001). Conclusions: In the real-world setting of a prospective national therapy registry, the application of current therapeutic guidelines for patients with moderate to severe psoriasis resulted in a PASI reduction of approximately 70% within the first year of treatment, but current therapeutic targets of PASI75 and PASI90 were reached in only 58 and 36% of patients, respectively, at 1 year, highlighting a gap in efficacy between selective clinical trials and the real-world setting.

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Factors Associated with Drug Survival of Methotrexate and Acitretin in Patients with Psoriasis

Cited by 29 publications

References 31 publications

Drug survival of methotrexate in psoriasis

Drug survival of methotrexate in psoriasis

Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

Efficacy and Survival of Systemic Psoriasis Treatments: An Analysis of the Swiss Registry SDNTT

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