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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 31 octobre 2019
Doi : 10.1016/j.jaad.2019.05.064
accepted : 23 May 2019
Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study
 

Emanuele Cozzani, MD, PhD a, , Yiran Wei, MD a, Martina Burlando, MD a, Alessio Signori, PhD b, Aurora Parodi, MD a
a Section of Dermatology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy 
b Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy 

Reprint requests: Emanuele Cozzani, MD, PhD, Section of Dermatology, San Martino Polyclinic Hospital, Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Genoa, Italy.Section of DermatologySan Martino Polyclinic HospitalDepartment of Health SciencesUniversity of GenoaVia Pastore 1Genoa16132Italy
Abstract
Background

Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched.

Objective

We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival.

Methods

In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan–Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival.

Results

Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P  = .0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0 years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P  = .014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P  = .003, hazard ratio 0.48).

Limitations

As a single-center, retrospective real-life study, the data were not perfectly homogeneous.

Conclusion

Switching between biologic classes might increase drug survival but retrospective studies designed ad hoc are needed to confirm this better switching strategy.

The full text of this article is available in PDF format.

Key words : biologic drugs, drug survival, psoriasis, switch

Abbreviations used : CI, EADV, HR, PASI, PASI75, PASI90, PASI100, TNF, TNFi



 Dr Cozzani and Dr Wei contributed to this work equally.
 Funding sources: None.
 Conflicts of interest: None disclosed.



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