Biologic treatment sequences in moderate-to-severe psoriasis

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology Pub Date : 2024-07-22 DOI:10.1111/ajd.14350

Samantha Ting MD, FRACGP, Patricia Lowe MBBS, MMed, FACD, Annika Smith MBBS, MPHTM, FRACP, FACD, Pablo Fernández-Peñas MD, PhD, FACD

{"title":"Biologic treatment sequences in moderate-to-severe psoriasis","authors":"Samantha Ting MD, FRACGP, Patricia Lowe MBBS, MMed, FACD, Annika Smith MBBS, MPHTM, FRACP, FACD, Pablo Fernández-Peñas MD, PhD, FACD","doi":"10.1111/ajd.14350","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The advent of novel biologics has led to an increase in biologic-switching as patients and clinicians pursue improved clinical outcomes. However, guidance on treatment sequencing in an Australian setting is sparse. This study examines the patterns of care across two tertiary centres in Australia and characterizes the factors contributing to biologic-switching.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective study of patients who attended the outpatient Dermatology biologic clinics across two tertiary hospitals was conducted. Data on treatment sequencing and patients' PASI at every visit from April 2006 to December 2020 were collected. Patterns of biologic-switching were examined. The speed of treatment response for each biologic was determined by the time to achieve PASI-90 and -100 for each treatment course.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 440 treatment courses were analysed. Ustekinumab and adalimumab were the most frequently prescribed first-line biologics. The highest proportion of biologic-switching was observed among patients on TNF-α inhibitors (63.8%). After 2015, more patients were prescribed IL-12/23 and IL-17 inhibitors in favour of TNF-α inhibitors. IL-17 inhibitors demonstrated the most rapid treatment response and low PASI scores relative to other biologics. Patients who did not switch biologics had lower rates of psoriatic arthritis and lower BMI, compared to patients who switched biologics. The median PASI on discontinuation generally exceeded 3.0, while on continuation, it was less than 1.2, reflecting patients' and clinicians' thresholds for biologic-switching.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study demonstrates an increased uptake of more novel biologics as they become available, due to improved safety profiles and clinical outcomes.</p>\n </section>\n </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e178-e186"},"PeriodicalIF":2.2000,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14350","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australasian Journal of Dermatology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ajd.14350","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The advent of novel biologics has led to an increase in biologic-switching as patients and clinicians pursue improved clinical outcomes. However, guidance on treatment sequencing in an Australian setting is sparse. This study examines the patterns of care across two tertiary centres in Australia and characterizes the factors contributing to biologic-switching.

Methods

A retrospective study of patients who attended the outpatient Dermatology biologic clinics across two tertiary hospitals was conducted. Data on treatment sequencing and patients' PASI at every visit from April 2006 to December 2020 were collected. Patterns of biologic-switching were examined. The speed of treatment response for each biologic was determined by the time to achieve PASI-90 and -100 for each treatment course.

Results

A total of 440 treatment courses were analysed. Ustekinumab and adalimumab were the most frequently prescribed first-line biologics. The highest proportion of biologic-switching was observed among patients on TNF-α inhibitors (63.8%). After 2015, more patients were prescribed IL-12/23 and IL-17 inhibitors in favour of TNF-α inhibitors. IL-17 inhibitors demonstrated the most rapid treatment response and low PASI scores relative to other biologics. Patients who did not switch biologics had lower rates of psoriatic arthritis and lower BMI, compared to patients who switched biologics. The median PASI on discontinuation generally exceeded 3.0, while on continuation, it was less than 1.2, reflecting patients' and clinicians' thresholds for biologic-switching.

Conclusions

This study demonstrates an increased uptake of more novel biologics as they become available, due to improved safety profiles and clinical outcomes.

Abstract Image

查看原文本刊更多论文

中度至重度银屑病的生物治疗序列。

背景：随着新型生物制剂的出现，患者和临床医生为了追求更好的临床疗效，越来越多地更换生物制剂。然而，澳大利亚的治疗排序指南却很少。本研究探讨了澳大利亚两家三级医疗中心的治疗模式，并分析了导致生物制剂转换的因素：方法：本研究对两家三级医院皮肤科生物门诊的患者进行了回顾性研究。研究收集了 2006 年 4 月至 2020 年 12 月期间每次就诊时的治疗排序和患者 PASI 数据。对生物制剂转换模式进行了研究。根据每个疗程达到 PASI-90 和 -100 的时间来确定每种生物制剂的治疗反应速度：结果：共分析了 440 个疗程。乌司替库单抗和阿达木单抗是最常处方的一线生物制剂。在使用 TNF-α 抑制剂的患者中，生物制剂转换的比例最高（63.8%）。2015年后，越来越多的患者开始使用IL-12/23和IL-17抑制剂，而不再使用TNF-α抑制剂。与其他生物制剂相比，IL-17抑制剂的治疗反应最快，PASI评分较低。与更换生物制剂的患者相比，未更换生物制剂的患者患银屑病关节炎的比例较低，体重指数也较低。停药时的 PASI 中位数通常超过 3.0，而继续用药时则低于 1.2，这反映了患者和临床医生对更换生物制剂的阈值：这项研究表明，随着更多新型生物制剂的上市，其安全性和临床疗效都会得到改善，因此患者对它们的接受度也会提高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Australasian Journal of Dermatology 医学-皮肤病学

CiteScore

3.20

自引率

5.00%

发文量

186

审稿时长

6-12 weeks

期刊介绍： Australasian Journal of Dermatology is the official journal of the Australasian College of Dermatologists and the New Zealand Dermatological Society, publishing peer-reviewed, original research articles, reviews and case reports dealing with all aspects of clinical practice and research in dermatology. Clinical presentations, medical and physical therapies and investigations, including dermatopathology and mycology, are covered. Short articles may be published under the headings ‘Signs, Syndromes and Diagnoses’, ‘Dermatopathology Presentation’, ‘Vignettes in Contact Dermatology’, ‘Surgery Corner’ or ‘Letters to the Editor’.