Modificación de la dosis de terapias biológicas en psoriasis moderada-grave: análisis descriptivo en condiciones de práctica clínica

Baniandrés, Ofelia; Rodríguez-Soria, V.J.; Romero‐Jiménez, Rosa; Suárez, Ricardo

doi:10.1016/j.ad.2015.02.003

Cited by 17 publications

(4 citation statements)

References 19 publications

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“…The dose-optimization studies in real-life clinical contexts included in our systematic review evaluated the different types of interventions, including dose reduction ( n = 4) [32–35], implementation of optimization protocols ( n = 4) [36–39], dose spacing ( n = 1) [40], optimization/escalation strategies ( n = 1) [41], inclusion of multi-disciplinary committees ( n = 1) [42] and switching to a biosimilar ( n = 1) [43]. The PSO studies [32, 33, 36, 37, 40, 41, 43] all included the pharmacological costs with a time horizon of 1 year, with one exception, namely, a solitary study that used a horizon of 4 years and failed to specify the type of cost included in the analysis [36]. All PsA studies ( n = 5) [34, 35, 38, 39, 42] used the perspective of the NHS, with a time horizon of between 6 months and 7 years (ESM Table S3).…”

Section: Resultsmentioning

confidence: 99%

“…The total annual cost of a reduced ETN regime for the treatment of PSO varied from €4160 (50 mg/2 weeks) to €8320/patient-year (25 mg/week), whereas the escalated regime increased the annual cost up to €23,773/patient-year [32]. Dose optimization procedures for ETN doses in the treatment of PSO through the implementaion of optimization/escalation strategies and protocols resulted in a saving of €859/patient-year [37] (Table 3).…”

Section: Resultsmentioning

confidence: 99%

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Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Puig

Fernández‐Freire

Burgos

et al. 2019

Dermatol Ther (Heidelb)

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Introduction Etanercept (ETN), a highly effective biological agent for the treatment of psoriasis (PSO) and psoriatic arthritis (PsA), is widely used in Spain. However, evidence of its economic impact is limited, indicating the need for a systematic review of the economic assessments conducted on the use of ETN in the treatment of both PSO and PsA in Spain. Methods A systematic review was carried out in PubMed, Embase, Cochrane Library, Health Technology Assessment reports and not indexed sources up to November 2018. The inclusion criteria were economic evaluations (total and partial) and dose optimization studies published in English or Spanish on the use of ETN to treat PSO and PsA for ETN in Spain. Results A total of 402 publications were identified, of which 32 were selected for inclusion in the review; of these 32 publications, 81.3% analyzed PSO (14 full economic evaluations, 5 partial economic evaluations and 7 dose optimization studies) and 18.8% analyzed PsA (1 economic analysis and 5 dose optimization studies). The perspective of the Spanish National Health Service (NHS) was used in 90.0% ( n = 18) of the full and partial economic evaluations. The time horizons ranged from 12 weeks to 2 years. Reductions in the Psoriasis Area and Severity Index (PASI) of 50, 75 and 90% (PASI 50, 75 and 90, respectively) were most commonly used as efficacy outcomes in the complete evaluations. The economic impact of ETN ranged from €9110–14,337/PASI 75 at 12 weeks (50 mg/week) to €82,279/PASI 90 at 2 years, depending on the health outcome, time horizon and ETN dose used. Only one study determined the cost of using ETN for the treatment of PSO (€29,430–52,367/QALY for dose 2 × 25 mg/week or 50 mg/week, respectively). Only one partial economic evaluation on PSA was identified (NHS perspective), resulting in an ETN annual cost of €8585/patient-year. Conclusion Consistent evidence on the economic impact of ETN for the treatment of PSO and PSA in Spain is lacking, mainly due to the highly heterogeneous methodology used and the broad range of outcomes found in the economic evaluations published to date. Funding Pfizer S.L.U. Electronic supplementary material The online version of this article (10.1007/s13555-019-0301-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Puig

Fernández‐Freire

Burgos

et al. 2019

Dermatol Ther (Heidelb)

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“…However, several studies have reported on the effects of DR in biologic therapies for psoriasis. Regarding the first generation biologics, several observational studies showed that DR of adalimumab, etanercept and ustekinumab is possible and safe in patients with low disease activity without losing disease control [3,4,9,15,16,[19][20][21]. In addition, a randomized controlled trial showed non-inferiority regarding quality of life but not regarding disease activity, although DR of adalimumab, etanercept, and ustekinumab was possible in 53% of patients, without safety concerns [2].…”

Section: Discussionmentioning

confidence: 99%

Attitudes and behaviour regarding dose reduction of biologics for psoriasis: a survey among dermatologists worldwide

et al. 2021

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Dose reduction (DR) of biologics, where possible, seems promising for more efficient use of expensive biologics. For implementation of DR strategies, it is essential to get insight in factors that influence implementation. The objective of this study was to evaluate the attitudes and behaviour regarding dose reduction of biologic therapies for psoriasis among psoriasis expert dermatologists worldwide. A 27-question e-survey was sent through the International Psoriasis Council (IPC) to its 114 dermatologist councilors worldwide. The survey assessed demographics, general and DR prescription behaviour, and motivations for and barriers against application of DR. Of 57 respondents, 53 respondents who prescribed biologics were included for analysis. Thirty-seven (69.8%) applied DR (i.e., ‘DR dermatologists’), and 16 (30.2%) did not (i.e., ‘Non-DR dermatologists’). DR strategies varied among respondents. Regarding criteria for starting DR, differences were reported in required treatment duration, and interpretation and duration of stable low disease activity. In addition, the prolongation of intervals between injections varied between respondents. For most ‘DR dermatologists’ (n = 32/37, 86.5%), cost savings were one of the main reasons to apply DR. Fifteen out of 16 ‘Non-DR dermatologists’ (94%) did not apply DR due to lack of scientific evidence. In conclusion, DR of biologics for psoriasis is part of clinical practice in psoriasis experts globally. Barriers for applying DR included lack of evidence or guidelines, and uncertainty on DR effects and risks. Although growing evidence shows DR feasibility, future studies are needed to accumulate and broaden evidence, along with development of (inter)national guidelines on DR strategies.

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“…Moreover, biological drugs are expensive, which translates into high healthcare costs worldwide [46][47][48][49]. However, off label optimization (dose reduction or increase in the interval of drug administration) of biological drug dosage represents a therapeutic alternative for patients who exhibit an excellent response in clinical practice [46][47][48][49][50]. In a previous publication by our group, we found an association of SNPs located on LMO4, IL28RA, CYLD, IL12B, TNFAIP3 and VEGFA genes with overall and successful dose reduction for biological drugs (N = 120).…”

Section: Anti-tnf Drugsmentioning

confidence: 99%

Pharmacogenetics Update on Biologic Therapy in Psoriasis

et al. 2020

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Background and objectives: Psoriasis is a chronic immune-mediated skin disease caused by several complex factors, both environmental and genetic, many of which are still not fully understood. Nowadays, several groups of biological drugs are being used for psoriasis treatment. Although these therapies are very effective, they show significant variability in efficacy among individuals. Therefore, there is a need for biomarkers to predict treatment outcomes in order to guide personalized therapeutic decisions. Pharmacogenetics is the study of variations in DNA sequences related to drug response. Materials and Methods: In this article, we review pharmacogenetics studies on the treatment of moderate-to-severe psoriasis focusing on anti-interleukin (IL) 12/23 (ustekinumab) and anti-IL17 drugs (secukinumab and ixekizumab), as well as recent studies concerning anti-TNF drugs. Results: Several polymorphisms have been studied over the years in reference to anti-TNF drugs; some of the most recent studies included the performance of a genome-wide association study (GWAS) and pharmacogenetics studies focused on the optimization of a treatment regimen. Various polymorphisms in different genes have been related to ustekinumab response; among them, the most commonly studied is the HLA-C*06:02 allele. Conclusions: Although not confirmed in some studies, most studies have shown that patients carrying this allele present a significantly higher response rate to ustekinumab. Some polymorphisms have been studied in patients treated with anti-IL17 drugs, mostly related to secukinumab; however, up to now, no association has been found between any of these polymorphisms and response. Nevertheless, further studies involving larger cohorts are needed in order to confirm these results before the implementation of this biomarker in clinical practice.

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Modificación de la dosis de terapias biológicas en psoriasis moderada-grave: análisis descriptivo en condiciones de práctica clínica

Cited by 17 publications

References 19 publications

Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Attitudes and behaviour regarding dose reduction of biologics for psoriasis: a survey among dermatologists worldwide

Pharmacogenetics Update on Biologic Therapy in Psoriasis

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