Background Adherence is an overall marker of treatment success, and it depends on multiple factors including efficacy and safety. Despite the wide use of tumour necrosis factor (TNF)-alpha blockers in the treatment of plaque-type psoriasis, few data regarding treatment adherence in routine clinical practice are available. Objectives To estimate the long-term survival rate of anti-TNF-alpha therapy in a cohort of patients with psoriasis in routine clinical practice; to evaluate the reasons for and predictors of treatment discontinuation. Methods The Outcome and Survival rate Concerning Anti-TNF Routine treatment (OSCAR) study was based on a retrospective analysis to estimate the long-term survival rate of the first anti-TNF-alpha treatment in patients with psoriasis, from three Italian academic referral centres. Adult patients (n = 650) with plaque psoriasis treated with a first course of adalimumab, etanercept or infliximab for = 3 months were included. Results Global adherence to anti-TNF-alpha treatments after 28.9 +/- 15.4 months (867 +/- 462 days) of observation was 72.6%. Etanercept showed a longer survival (mean 51.4 months, 1565 days; P < 0.001) compared with infliximab (36.8 months, 1120 days) and adalimumab (34.7 months, 1056 days). Treatment discontinuation due to primary and secondary inefficacy was observed in 5.2% and 14.5% of patients, respectively, whereas discontinuation due to adverse events was reported in 29 subjects (4.5%). Independent predictors of treatment withdrawal were female gender [hazards ratio (HR) 1.3], treatment with adalimumab or infliximab compared with etanercept (HR 2.7 and 1.7, respectively), and the concomitant use of traditional systemic treatment, as a rescue therapy, compared with monotherapy (HR 1.9). Conclusions Overall survival of anti-TNF-alpha agents in psoriasis is elevated, with drug discontinuation mostly due to inefficacy. Etanercept showed a longer adherence compared with adalimumab and infliximab.
Survival rate of antitumour necrosis factor- treatments for psoriasis in routine dermatological practice: a multicentre observational study
Esposito M;
2013-01-01
Abstract
Background Adherence is an overall marker of treatment success, and it depends on multiple factors including efficacy and safety. Despite the wide use of tumour necrosis factor (TNF)-alpha blockers in the treatment of plaque-type psoriasis, few data regarding treatment adherence in routine clinical practice are available. Objectives To estimate the long-term survival rate of anti-TNF-alpha therapy in a cohort of patients with psoriasis in routine clinical practice; to evaluate the reasons for and predictors of treatment discontinuation. Methods The Outcome and Survival rate Concerning Anti-TNF Routine treatment (OSCAR) study was based on a retrospective analysis to estimate the long-term survival rate of the first anti-TNF-alpha treatment in patients with psoriasis, from three Italian academic referral centres. Adult patients (n = 650) with plaque psoriasis treated with a first course of adalimumab, etanercept or infliximab for = 3 months were included. Results Global adherence to anti-TNF-alpha treatments after 28.9 +/- 15.4 months (867 +/- 462 days) of observation was 72.6%. Etanercept showed a longer survival (mean 51.4 months, 1565 days; P < 0.001) compared with infliximab (36.8 months, 1120 days) and adalimumab (34.7 months, 1056 days). Treatment discontinuation due to primary and secondary inefficacy was observed in 5.2% and 14.5% of patients, respectively, whereas discontinuation due to adverse events was reported in 29 subjects (4.5%). Independent predictors of treatment withdrawal were female gender [hazards ratio (HR) 1.3], treatment with adalimumab or infliximab compared with etanercept (HR 2.7 and 1.7, respectively), and the concomitant use of traditional systemic treatment, as a rescue therapy, compared with monotherapy (HR 1.9). Conclusions Overall survival of anti-TNF-alpha agents in psoriasis is elevated, with drug discontinuation mostly due to inefficacy. Etanercept showed a longer adherence compared with adalimumab and infliximab.Pubblicazioni consigliate
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