Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)
Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)
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DOI：
10.1111/bjd.15027
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发表时间：
2017-05-01
影响因子：
10.3
通讯作者：
Griffiths, C. E. M.
中科院分区：
文献类型：
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作者：
Iskandar, I. Y. K.;Ashcroft, D. M.;Griffiths, C. E. M.
背景在银屑病的治疗中，包括剂量的增加、剂量的减少、更换、停用和重新开始等治疗改进可能是必要的，但其使用模式还不完全确定。目的研究在英国皮肤科医生协会生物干预登记(BADBIR)登记的生物幼稚和非幼稚银屑病患者中阿达利单抗、依那西普和乌司匹林单抗的治疗使用模式。在第一年的治疗中评估了治疗的改进。时间趋势法将患者接受的累积剂量(CD)与推荐的累积剂量(RCD)进行比较，以评估剂量模式。结果共纳入2980例患者(阿达利单抗：1675例；依那西普：996例；乌司匹林单抗：309例)；792%的患者是生物幼稚的。在超过12个月的时间里，774%的患者继续接受生物治疗，26%的患者在中断90天后重新开始治疗，25%的患者停止治疗，175%的患者改用生物治疗。大多数患者(857%)接受了生物的RCD，尽管81%的患者暴露于更高的CD。总体而言，749名(251%)患者在某个阶段同时使用常规系统疗法和生物疗法；最常用的是甲氨蝶呤(458例；612%)。在使用联合治疗的患者中，454人(606%)在生物治疗开始120天后继续使用传统的系统治疗。结论超过三分之一的患者在开始生物治疗的第一年内经历了治疗修改。传统的全身疗法，特别是甲氨蝶呤，通常是同时使用的，在现实世界的观察性研究中，当评估对生物制剂的治疗反应和不良事件时，应该考虑这一点。
BackgroundTreatment 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.ObjectivesTo examine the treatment utilization patterns of adalimumab, etanercept and ustekinumab among biologic-naive and non-naive patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR).MethodsThe 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.ResultsIn total, 2980 patients (adalimumab: 1675; etanercept: 996; ustekinumab: 309) were included; 792% were biologic-naive. Over 12 months, 774% of patients continued the biologic, 26% restarted therapy after a break of 90 days, 25% discontinued, and 175% switched biologic therapy. Most patients (857%) received the RCD of the biologic, although 81% were exposed to a higher CD. In total, 749 (251%) patients used conventional systemic therapies concomitantly with a biologic at some stage; methotrexate was used most commonly (458; 612%). Of those using combination therapy, 454 (606%) continued the use of the conventional systemic therapy for > 120 days after the start of the biologic.ConclusionsMore 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.