Patient Comorbidities and Severity of Psoriasis Correlate With Choice of Systemic Therapy

Several factors influence the choice of prescription systemic therapies for plaque psoriasis, with comorbidities and disease severity playing primary roles in clinical decision making, study findings published in the Journal of European Academy of Dermatology and Venereology suggest.

The Swiss Dermatology Network for Targeted Therapies registry in Switzerland was retrospectively reviewed for baseline data from patients with chronic plaque psoriasis who were included in the registry between March 2011 and December 2017. Only patients who had started a new systemic therapy for psoriasis were included in the analysis (n=549; mean age, 46.7±14.7 years). An “a priori” list of baseline variables and their associations with prescribed systemic therapies was assessed.

Patient variables associated with prescribing retinoids and methotrexate included having no prior history of systemic therapies, a moderate quality of life (QoL) at the onset of therapy, and age ≥60 years, according to a semantic connectivity map created by the investigators. Individuals with mild psoriasis (psoriasis area severity index [PASI] <10) and disease duration lasting ≥20 years were more likely to receive fumaric acid derivatives.

Severe chronic plaque psoriasis, characterized by impaired QoL, hospitalization, and inability to work, was associated with the use of cyclosporine and psoralen and ultraviolet A/ultraviolet light B (PUVA/UVB) therapies. Psoriatic arthritis, severe disease, and the presence of chronic liver or kidney diseases were associated with the use of both infliximab and adalimumab. Patients with a complex history of prior systemic treatments for psoriasis (≥2 therapies), moderate disease (PASI, 10 to 20), and patients who were overweight and had a university education were associated with the use of etanercept, ustekinumab, and secukinumab.

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Study limitations include its exploratory and retrospective nature.

“Some important comorbidities like psoriatic arthritis, chronic liver disease, and chronic kidney disease were found in the center of the map and in association with biological therapies,” the researchers wrote, “indicating that they may influence the choice of these treatments.”

Disclosure: This clinical trial was supported by AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer. 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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Cazzaniga S, Anzengruber F, Augustin M, et al. Linkage between patients’ characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss SDNTT registry [published online September 28, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15983