Title

Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting.

Authors

Junko Takeshita, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, Department of Dermatology, University of Pennsylvania Perelman School of Medicine
Shuwei Wang, Thomas Jefferson UniversityFollow
Daniel B Shin, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, Department of Dermatology, University of Pennsylvania Perelman School of Medicine
Kristina Callis Duffin, Department of Dermatology, University of Utah School of Medicine
Gerald G Krueger, Department of Dermatology, University of Utah School of Medicine
Robert E Kalb, Department of Dermatology, State University of New York, Buffalo School of Medicine and Biomedical Sciences
Jamie D Weisman, Peachtree Dermatology Assoc., Atlanta, GA
Brian R Sperber, Colorado Springs Dermatology Clinic, Colorado Springs, CO
Michael B Stierstorfer, East Penn Dermatology, North Wales, PA
Bruce A Brod, Dermatology Assoc. of Lancaster, Lancaster, PA
Stephen M Schleicher, DermDox Centers for Dermatology, Hazleton, PA
Andrew D Robertson, National Psoriasis Foundation, Portland, OR
Kristin A Linn, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
Russell T Shinohara, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
Andrea B Troxel, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
Abby S Van Voorhees, Department of Dermatology, University of Pennsylvania Perelman School of Medicine
Joel M Gelfand, Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, Department of Dermatology, University of Pennsylvania Perelman School of Medicine

Document Type

Article

Publication Date

12-1-2014

Comments

This article has been peer reviewed. It was published in: Journal of the American Academy of Dermatology.

Volume 71, Issue 6, 1 December 2014, Pages 1167-1175.

The published version is available at DOI: 10.1016/j.jaad.2014.08.003

Copyright © 2014 American Academy of Dermatology, Inc.

Abstract

BACKGROUND: The effectiveness of psoriasis therapies in real-world settings remains relatively unknown.

OBJECTIVE: We sought to compare the effectiveness of less commonly used systemic therapies and commonly used combination therapies for psoriasis.

METHODS: This was a multicenter cross-sectional study of 203 patients with plaque psoriasis receiving less common systemic monotherapy (acitretin, cyclosporine, or infliximab) or common combination therapies (adalimumab, etanercept, or infliximab and methotrexate) compared with 168 patients receiving methotrexate evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network.

RESULTS: In adjusted analyses, patients on acitretin (relative response rate 2.01; 95% confidence interval [CI] 1.18-3.41), infliximab (relative response rate 1.93; 95% CI 1.26-2.98), adalimumab and methotrexate (relative response rate 3.04; 95% CI 2.12-4.36), etanercept and methotrexate (relative response rate 2.22; 95% CI 1.25-3.94), and infliximab and methotrexate (relative response rate 1.72; 95% CI 1.10-2.70) were more likely to have clear or almost clear skin compared with patients on methotrexate. There were no differences among treatments when response rate was defined by health-related quality of life.

LIMITATIONS: Single time point assessment may result in overestimation of effectiveness.

CONCLUSIONS: The efficacy of therapies in clinical trials may overestimate their effectiveness as used in clinical practice. Although physician-reported relative response rates were different among therapies, absolute differences were small and did not correspond to differences in patient-reported outcomes.