Lower Satisfaction With Biologic Psoriasis Treatment Observed in Women

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Treatment with biologics for psoriasis is not the same for men and women, a study shows, and may explain why women tend toward earlier discontinuation with biologic treatment.

Women receiving biological therapies for psoriasis reported lower satisfaction and more side effects compared with men, according to study data published in the Journal of the European Academy of Dermatology and Venereology.

Investigators abstracted data from the prospective, longitudinal Continuous Assessment of Psoriasis Treatment Use Registry with Biologics (BioCAPTURE registry). The BioCAPTURE registry collects daily practice data for patients with psoriasis from 16 centers in The Netherlands. Patients in the BioCAPTURE registry complete a treatment satisfaction questionnaire for medication (TSQM) at baseline and every 3 months until month 12, and annually thereafter. The TSQM comprises 4 domains, each scored out of 100: effectiveness, convenience, global satisfaction, and side effects. TSQM scores for each domain were assessed using linear mixed models, with results expressed as estimated marginal means (EMM) over time. Analyses were corrected for type of biologic, presence of psoriatic arthritis, psoriasis duration, baseline psoriasis severity, and body mass index. Adverse events over time were also extracted and compared in patient groups.

Data from 315 patients, comprising 396 treatment episodes, were extracted. Total patient-years in treatment were 417 years for women and 677 years for men. The majority of patients were men (n=188; 59.7%), and median baseline Psoriasis Area and Severity Index score was significantly higher in men compared with women (P =.01). Longitudinal analysis of TSQM “effectiveness” and “convenience” domain scores indicated no significant differences in men and women. However, the side effects domain score over time was lower in women (EMM: 78.65; 95% CI, 74.52-82.78) compared with men (EMM: 79.20; 95% CI, 74.52-82.78; P =.05). Women also had a lower global satisfaction score over time compared with men (female EMM: 71.57 [95% CI, 66.25-76.89]; male EMM: 78.69 [95% CI, 73.26-84.13]; P =.01). The number of serious adverse events recorded in women was not significantly different compared with men (41 vs 48; P =.13). However, adverse events of special interest occurred more frequently in women than in men (120 vs 109; P <.001). Specifically, women reported more mucosal fungal infections (rate ratio, 12.99; P <.001) and more herpes simplex infections (rate ratio, 3.25; P =.005). After stratifying by type of biologic, women had higher incidence rates of adverse events of special interest than men for etanercept (rate ratio, 2.29; P =.002) and infliximab (rate ratio, 9.89; P =.001).

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These data describe an unmet burden of treatment dissatisfaction and increased side effects in women with psoriasis. As a study based on questionnaire response, responder bias may affect results. Even so, these findings may provide explanation for the higher rate of biologics discontinuation observed in women compared with men. “Further clarifying the background of gender differences in psoriasis patients treated with biologics is valuable to increase awareness and provide more personalized care according to the patients’ needs,” investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures

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van der Schoot LS, van den Reek JMPA, Groenewoud JMM, et al. Female patients are less satisfied with biological treatment for psoriasis and experience more side-effects than male patients: results from the prospective BioCAPTURE registry. J Eur Acad Dermatol Venereol. 2019;33(10):1913-1920.