Patients with psoriasis who are undergoing treatment with biologic therapies experience improvements in health-related quality of life (HRQoL), which are influenced by the type of agent selected, baseline HRQoL, lifestyle characteristics, and comorbidities, according to the results of a recent prospective cohort study published in the British Journal of Dermatology.1
The current study compared the efficacy of several biologic agents, including adalimumab, etanercept, and ustekinumab, on HRQoL in patients with psoriasis. Changes in HRQoL were assessed using the Dermatology Life Quality Index (DLQI) and the EuroQoL-5D (EQ-5D) utility score at 6 and 12 months.
A total of 2152 participants were enrolled in the study, with 1239 receiving adalimumab, 517 receiving etanercept, and 396 receiving ustekinumab. Of those being treated, 81% were biologic naive. In the entire cohort, median DLQI and EQ-5D improved significantly from scores of 18 and 0.73, respectively, at baseline to scores of 2 and 0.85, respectively, at 6 months (P <.001). Similar improvements were reported at 12 months.
Multivariable regression modeling at 12 months revealed that female gender, multiple comorbidities, smoking, and a higher DLQI or lower EQ-5D utility score at baseline were predictive of a lower likelihood of attaining a DLQI of 0/1 or an improvement in EQ-5D. When compared with adalimumab-treated patients, but not with ustekinumab-treated-patients, etanercept-treated patients were less likely to achieve a DLQI of 0/1. No significant differences were observed between the biologic treatment arms with respect to EQ-5D improvements.
The investigators concluded that the use of biologic agents to treat persons with psoriasis was associated with pronounced improvements in HRQoL over 12 months, which were influenced by the choice of biologic therapy and other patient-specific factors. These findings are particularly important as they lend support to the concept that lifestyle modifications, including cessation of smoking, may enhance the efficacy of biologic therapies in patients with psoriasis.
Iskandar IYK, Ashcroft DM, Warren RB, et al. Comparative effectiveness of biological therapies on improvements in quality of life in patients with psoriasis [published online March 30, 2017]. Br J Dermatol. doi: 10.1111/bjd.15531