The effects of selected biologics and a small molecule on Health-Related Quality of Life in adult plaque psoriasis patients: A systematic review and meta-analysis

Abstract

Background The Dermatology Life Quality Index (DLQI) is commonly used to assess the quality of life of patients with skin diseases. Clinical trials confirm the positive effect of the use of biologics and new molecules on the quality of life of patients with plaque psoriasis. Main objectives Investigation of the effect of infliximab, adalimumab, ixekizumab, secukinumab and tofacitinib on Health-Related Quality of Life (HRQOL) measured by the DLQI in adult plaque psoriatic patients with respect to the patients’ race, type of used agent/placebo, agent’s dosage and treatment duration as well as the DLQI score prior to and after commencement of treatment. Material and methods Systematic literature searching for referential papers written in English using four databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov as well as and manual searching (Google) Cochran’s (Q) and I2 tests were used for evaluation of heterogeneity or the degree of variation in the true effect size estimates between the analysed studies. The standardized mean difference (the SMD; Hedge’s g score) was applied to measure the differences between the two means (i.e. two groups: treated vs non-treated or treated vs placebo). The data coding and Hedge's g values were calculated according to the guidance of MetaXL software version 5.3. Main results 43 studies, in total 25,898 individuals, were evaluated by the DLQI and weighted mean scores were derived for the analysis. The mean DLQI scores ranged from 6.83 to 17.8 with the overall DLQI score of 12.12 (95%CI: 11.24 to 13.06). A random-effects model demonstrated significant considerable heterogeneity of the study results (I2 = 98%; p<0.001). Conclusion Infliximab, adalimumab, ixekizumab, secukinumab and tofacitinib in adult plaque psoriatic patients improved HRQOL measured by the DLQI. The patients with lower quality of life before treatment obtained better results.

Sharing Patient and Clinician Experiences of Moderate-to-Severe Psoriasis: A Nationwide Italian Survey and Expert Opinion to Explore Barriers Impacting upon Patient Wellbeing

“…The availability of biological agents, in particular, novel interleukins (IL) such as IL-17 and IL-23 inhibitors, has allowed dermatologists to successfully treat moderate-to-severe psoriasis, with many patients achieving clear skin [ 8 , 9 , 10 , 11 , 12 , 13 ] and improving their QoL [ 14 , 15 , 16 ]. However, many patients (e.g., moderate-to-severe psoriasis) may still be untreated/undertreated, decline or fail to respond to or experience side effects [ 17 , 18 ].…”

Could Targeted Pharmacotherapies Exert a “Disease Modification Effect” in Patients with Chronic Plaque Psoriasis?

“…The detrimental impact of psoriasis on the life course could be reduced via psychosocial interventions, such as patient education to improve coping and QoL [ 99 ] and/or via an early and effective therapeutic intervention. Randomized controlled trials demonstrated that patients with psoriasis treated with targeted pharmacotherapies showed a significant improvement in QoL, measured with the DLQI score, compared with other treatments [ 18 ]. It is reasonable to assume that this improvement in QoL is stronger the more effective the treatment is.…”

Response Types and Factors Associated with Response Types to Biologic Therapies in Patients with Moderate-to-Severe Plaque Psoriasis from Two Randomized Clinical Trials

“…Multiple biologic classes have demonstrated efficacy for the treatment of moderate-to-severe plaque psoriasis at set time points, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, an IL-12/23 inhibitor, and IL-23 inhibitors [ 3 , 4 ]. There is also evidence that these treatments can improve patients’ quality of life [ 5 , 6 ]. However, data on predictors and dynamics of response to biologic treatment are limited and primarily drawn from registry and retrospective studies [ 7 – 10 ].…”