Survival rate of antitumour necrosis factor-α treatments for psoriasis in routine dermatological practice: a multicentre observational study

Abstract

SummaryBackground Adherence is an overall marker of treatment success, and it depends on multiple factors including efficacy and safety. Despite the wide use of tumour necrosis factor (TNF)-a blockers in the treatment of plaque-type psoriasis, few data regarding treatment adherence in routine clinical practice are available. Objectives To estimate the long-term survival rate of anti-TNF-a therapy in a cohort of patients with psoriasis in routine clinical practice; to evaluate the reasons for and predictors of treatment discontinuation. Methods The Outcome and Survival rate Concerning Anti-TNF Routine treatment (OSCAR) study was based on a retrospective analysis to estimate the long-term survival rate of the first anti-TNF-a treatment in patients with psoriasis, from three Italian academic referral centres. Adult patients (n = 650) with plaque psoriasis treated with a first course of adalimumab, etanercept or infliximab for ≥ 3 months were included. Results Global adherence to anti-TNF-a treatments after 28Á9 AE 15Á4 months (867 AE 462 days) of observation was 72Á6%. Etanercept showed a longer survival (mean 51Á4 months, 1565 days; P < 0Á001) compared with infliximab (36Á8 months, 1120 days) and adalimumab (34Á7 months, 1056 days). Treatment discontinuation due to primary and secondary inefficacy was observed in 5Á2% and 14Á5% of patients, respectively, whereas discontinuation due to adverse events was reported in 29 subjects (4Á5%). Independent predictors of treatment withdrawal were female gender [hazards ratio (HR) 1Á3], treatment with adalimumab or infliximab compared with etanercept (HR 2Á7 and 1Á7, respectively), and the concomitant use of traditional systemic treatment, as a rescue therapy, compared with monotherapy (HR 1Á9). Conclusions Overall survival of anti-TNF-a agents in psoriasis is elevated, with drug discontinuation mostly due to inefficacy. Etanercept showed a longer adherence compared with adalimumab and infliximab.

Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review

“…Thirteen observational studies with 17,444 patients reported on the comparative risk of discontinuation of TIMs due to AEs (see Supplementary Table 1, available Six observational studies reported only crude rates of discontinuation and did not provide comparative estimates (22)(23)(24)(25)(26)(27). These studies generally observed a higher proportion of patients discontinuing infliximab than adalimumab, etanercept, or anakinra treatment due to AEs in CD, RA, and plaque psoriasis.…”

Long-term drug survival and predictor analysis of the whole psoriatic patient population on biological therapy in Hungary

“…Even though the disease is currently not curable, there are a number of therapeutic options which ensure a symptom-free status, although requires a long term, often lifelong treatment (3,4). Optimal drug survival is fundamental in the management of psoriasis and comorbidities (5).…”

“…Drug survival, that is, persistence, is a comprehensive measure of therapeutic success, which depends on a variety of factors, including efficacy, safety, tolerability and patient satisfaction (5). Suboptimal persistence is a common and complex problem among patients with chronic diseases, including psoriasis (6)(7)(8).…”

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

“…However, while biologics are generally very effective, 27% of patients treated with TNFα inhibitors were found to discontinue treatment after 29 months due to lack of initial efficacy (primary failure), loss of efficacy over time (secondary failure), or intolerance 32. Therefore, strategies are needed to maintain efficacy with acceptable tolerability.…”