Superiority in Quality of Life Improvement of Biologics over Conventional Systemic Drugs in a Swiss Real-Life Psoriasis Registry

Abstract

Background: Randomized controlled trials have shown the efficacy of systemic treatments in moderate-to-severe psoriasis. Clinical outcomes in psoriasis patients under real-world conditions are less well understood. Objective: This study compared Psoriasis Area and Severity Index (PASI) and Dermatological Life Quality Index (DLQI) improvement in all psoriasis patients registered in the Swiss Dermatology Network for Targeted Therapies. We asked whether outcomes differed between 4 treatment strategies, namely biologic monotherapy versus conventional systemic monotherapy, versus combined biologic and conventional systemic drugs, and versus therapy adaptation (switching from one type to another). Methods: PASI and DLQI within 1 year after onset of systemic treatment, measured at 3, 6, and 12 months, were compared among the 4 groups using generalized linear mixed-effects models. Results: Between March 2011 and December 2014, 334 patients were included; 151 received conventional systemic therapeutics, 145 biologics, 13 combined treatment, and 25 had a therapy adaptation. With regard to the absolute PASI, neither the biologic cohort nor the combined treatment cohort significantly differed from the conventional systemic therapeutics cohort. The odds of reaching PASI90 was significantly increased with combined therapy compared to conventional systemic therapeutics (p = 0.043) and decreased with a higher body mass index (p = 0.041). At visits 3 and 4, the PASI was generally lower than at visit 2 (visit 3 vs. visit 2, p = 0.0019; visit 4 vs. visit 2, p < 0.001). After 12 months, patients with biologic treatment had a significantly lower DLQI than those with conventional systemic therapeutics (p = 0.001). Conclusion: This study suggests that after 1 year of treatment, biologics are superior in improving the subjective disease burden compared to conventional systemic drugs.

Linkage between patients’ characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss Dermatology Network for Targeted Therapies registry

“…In our data set, the mean age of patients was 47 years, with a predominance of men, overweight patients and smokers (50%) and with 23% of patients presenting PsA. These characteristics were in‐line with previous reports from the SDNTT registry and results from pooled analyses of other national registries …”

“…This was a retrospective analysis of baseline data collected within the SDNTT registry between March 2011 and December 2017 . All patients gave written informed consent before inclusion in the registry.…”

“…This was a retrospective analysis of baseline data collected within the SDNTT registry between March 2011 and December 2017. 13,14 All patients gave written informed consent before inclusion in the registry. The registry agreed with the Declaration of Helsinki and was approved by the local ethics committee of each participating centre.…”

Acne and hidradenitis suppurativa

“…The hair follicle is considered ‘immune privileged’ as, at certain times in the hair cycle, it can protect itself from immune recognition and inflammatory responses via a loss of major histocompatibility complex class I and II expression, and by expressing CD200, α‐melanocyte‐stimulating hormone, TGF‐β2, macrophage migration inhibitory factor and indoleamine‐2,3‐dioxygenase . The role of TGF‐β2 may be especially interesting because a confirmed genome‐wide significant signal was found close by in patients with acne, and the authors also found TGF‐β2 to be downregulated in fresh acne biopsies …”

“…131,135 The role of TGF-b2 may be especially interesting because a confirmed genome-wide significant signal was found close by in patients with acne, and the authors also found TGF-b2 to be downregulated in fresh acne biopsies. 136 Multiple immune cells, including Langerhans cells, T cells (CD4 + and CD8 + ), macrophages and mast cells are commonly located in and around the hair follicle. 135 Langerhans cells have been a particular focus of recent study.…”