Background and importance Psoriasis is a chronic inflammatory skin disease. Pharmacological therapy in moderate-severe psoriasis requires systemic hospital-dispensed treatments (SHDT) whose objective is to improve quality of life.
Aim and objectives The primary endopoint of the study was to determine the cause for discontinuity (CD) of SHDT against psoriasis. The secondary objective was to analyse the CD by drug.
Material and methods An observational, descriptive and retrospective study was carried out on the population diagnosed with psoriasis and SHDT between 2016 and 2020 under follow-up by dermatology at our hospital. Data were obtained from the medical records and prescription medications program.
The CDs were grouped into seven items: lack/loss of efficacy, lack of adherence, patient decision, unacceptable toxicity, loss to follow-up, death, and others.
The drugs included were: adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab.
Results 205 SHDTs for psoriasis were reviewed: 70 ustekinumab, 37 adalimumab, 28 secukinumab, 24 apremilast, 15 etanercept, 15 ixekizumab, 9 guselkumab, 4 brodalumab, 2 infliximab and 1 tildrakizumab. 86 treatment discontinuations were described: 53.5% lack/loss of effectiveness, 20.9% lack of adherence, 10.5% loss of follow-up, 7% other reasons, 4.7% unacceptable toxicity, 4.7% death and 3.5% patient decision.
51.2% of the incidents were with ustekinumab. 17.4% of discontinuations occurred in the adalimumab group, 9.3% apremilast, 9.3% etanercept, 9.3% secukinumab, 2.3% infliximab and 1.2% guselkumab.
100% of the infliximab discontinued treatments were due to lack of adherence, 100% of the treatment discontinuities due to unacceptable toxicity were associated with apremilast, and 100% of the losses to follow-up were detected in ustekinumab.
Conclusion and relevance The main CD in SHDT for psoriasis in our centre is due to lack/loss of response. Ustekinumab has been the drug that has registered the most discontinuations and losses to follow-up; this is explained by it being the treatment with the highest prevalence in the study. Visiting the hospital for infliximab administration has been shown to reduce adherence and interrupt treatment in patients who receive it.
The increment in SHDT that appeared in recent years to treat psoriasis increases the therapeutic options. Knowing the main CD of the different drugs and the characteristics of the patients helps to individualise the treatment.
Conflict of interest No conflict of interest
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