Background Psoriasis is a chronic skin disease characterised by the development of inflamed spots on the skin. When first-line treatments fail (phototherapy, external corticoids, ciclosporin and methotrexate), biological treatments (BT) are tried.
Purpose To analyse and compare survival time (ST) of the first BT strategies used in psoriasis treatment as an indicator of effectiveness and tolerance.
Materials and methods Observational, retrospective, and analytical study performed in a 650-bed teaching hospital. We reviewed outpatient dispensing profile and clinical records (Farmatools 2.4) from September 2009 to June 2013 of adult patients with psoriasis and their first BT prescription (etanercept, adalimumab, ustekinumab and infliximab). Variables: sex, age, BT posology, cause of BT change (inefficacy or intolerance) and time to event (defined as any change in BT). Descriptive statistics and Kaplan Meier survival analysis were performed (SPSS 15.0).
Results Total of 73 patients reviewed met inclusion criteria (43 men 58.9%, 30 women 41.1%) (median age 29 years). BT prescription profiles were: etanercept 50 mg/week (28 patients -40.6%, 9 of these patients used 100 mg per week for the first 12 weeks), adalimumab 40 mg/2 weeks (22 patients - 26.6%), ustekinumab 45 mg/ quarter (17 patients - 24.25%) 90 mg/ quarter (6 patients - 8.55%) and infliximab (0 patients).
BT change: Etanercept patients (15 patients - 88.2% - changed drug and 2 -11.8% - dose increase), adalimumab patients (8–88.8% - drug change and 1a 11.2% frequency increase), ustekinumab (0 patients). There were no intolerance events.
The median survival time was 493 days with etanercept, 911.3 days with adalimumab and not evaluable by survival analysis with ustekinumab (p = 0.04).
Conclusions There are significant differences in ST between etanercept, adalimumab and ustekinumab in psoriasis patients. Etanercept is the most prescribed drug, even though Etanercept ST is significantly smaller in comparison with adalimumab and ustekinumab. The analysis and monitoring of ST in clinical practice setting is an excellent tool to measure the effectiveness and security profile of the first BTs.
No conflict of interest.
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