Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

• Published in: British journal of dermatology (1951) Vol. 176; no. 5; pp. 1297 - 1307
• Main Authors: Iskandar, I.Y.K., Ashcroft, D.M., Warren, R.B., Evans, I., McElhone, K., Owen, C.M., Burden, A.D., Smith, C.H., Reynolds, N.J., Griffiths, C.E.M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.05.2017
• Subjects: Adalimumab - therapeutic use; Biological Products - therapeutic use; Biological Therapy - utilization; Chronic Disease; Cohort analysis; Cohort Studies; Dermatologists; Dermatology; Drug Substitution - statistics & numerical data; Etanercept; Etanercept - therapeutic use; FDA approval; Female; Humans; Male; Methotrexate; Middle Aged; Monoclonal antibodies; Practice Patterns, Physicians; Psoriasis; Psoriasis - drug therapy; Registries; United Kingdom; Ustekinumab - therapeutic use
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.15027

Summary Background Treatment modifications, including dose escalations, dose reductions, switches, discontinuations and restarts of biologics may be necessary in the management of psoriasis but the patterns of usage are incompletely defined. Objectives To examine the treatment utilization patterns of adalimumab, etanercept and ustekinumab among biologic‐naïve and non‐naïve patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR). Methods The study cohort included adults with chronic plaque psoriasis who were followed up for ≥ 12 months. Treatment modifications were assessed during the first year of therapy. The time–trend method, comparing the cumulative dose (CD) patients received with the recommended cumulative dose (RCD), was used to assess dosing patterns. Concomitant use of other systemic treatments was also examined. Results In total, 2980 patients (adalimumab: 1675; etanercept: 996; ustekinumab: 309) were included; 79·2% were biologic‐naïve. Over 12 months, 77·4% of patients continued the biologic, 2·6% restarted therapy after a break of ≥ 90 days, 2·5% discontinued, and 17·5% switched biologic therapy. Most patients (85·7%) received the RCD of the biologic, although 8·1% were exposed to a higher CD. In total, 749 (25·1%) patients used conventional systemic therapies concomitantly with a biologic at some stage; methotrexate was used most commonly (458; 61·2%). Of those using combination therapy, 454 (60·6%) continued the use of the conventional systemic therapy for > 120 days after the start of the biologic. Conclusions More than one‐third of patients experienced treatment modifications within the first year of initiating a biologic. Conventional systemic therapies, particularly methotrexate, were commonly used concurrently, which should be considered when evaluating treatment response and adverse events to biologics in real‐world observational studies. What's already known about this topic? Published evidence concerning the utilization patterns of biologic therapies for psoriasis, including dosing, switching, discontinuation and restarts is limited to biologic‐naïve patients. Furthermore, the ability to determine the patterns of concomitant use of conventional systemic therapies with biologic therapies is confined to a few small‐scale studies. What does this study add? Based on a cohort of 2980 patients receiving biologic therapies for psoriasis, 33·7% of patients experienced treatment modifications during their first year of treatment. There were no significant differences between biologic‐naïve and non‐naïve patients in the proportions of patients who switched, discontinued or restarted therapy. Conventional systemic therapies, particularly methotrexate, were commonly used concurrently with biologics. Respond to this article Plain language summary available online