Long-term persistence of treatment with conventional drugs is low in patients with psoriasis, according to study results published in the British Journal of Dermatology.

The treatment of psoriasis often requires long-term therapeutics use. Researchers aimed to determine the persistence of ciclosporin, methotrexate, and acitretin (“conventional”) use in patients with psoriasis.

Data for 73,168 (41% women) new users of conventional treatments were obtained from the French National Health Insurance database. Discontinuation of treatment was defined as failure to refill a prescription within 90 days after the period covered by the previous prescription. The mean age of individuals included in the study was 52.1 years, and the mean follow-up time was 4.2±2.5 years.

During the duration of follow-up, 65,631 (89.7%) patients discontinued treatment. The persistence rate at 1 year was 25%. Though acitretin was the most commonly prescribed conventional therapeutic, persistence at 1 year was the lowest at 15%. The rates of persistence for ciclosporin and methotrexate were 20% and 42%, respectively. Of those patients who discontinued treatment within the first year, 66% did not start any new systemic treatment within the following year. Of the remaining 34% who did reinitiate systemic treatment, 72% did so within the first 6 months, and 57% reinitiated the same treatment; 25% switched to another form of conventional treatment, and 18% switched to the use of a biologic.


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With acitretin use as the reference standard, multivariate analysis was performed to identify predictors of treatment persistence and discontinuation. Treatment with ciclosporin (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.72-0.79) and treatment with methotrexate (aHR, 0.5; 95% CI, 0.49-0.51) were predictive of persistence. Age >40 years and male sex were also predictive of persistence, as well as psoriatic arthritis, inflammatory bowel disease, hypertension, dyslipidemia, hepatic disease, kidney disease, and cancer. Age <30 years was predictive of discontinuation.

The study authors noted that although persistence is often used as an indicator of the safety and efficacy of treatment, it does not account for other reasons that may lead to discontinuation. More robust observational perspective studies are recommended to assess the causes of discontinuation of treatment.

The researchers also note that the persistence rate observed for conventional treatments is much lower than has been previously identified for biologics. “This observation may reflect the higher efficacy and safety of biologic treatment,” the authors postulate. “However, this might also reflect the higher severity of psoriasis in patients on biological treatments. Indeed, in France, a biological agent can only be prescribed after the contraindication of, intolerance to or failure of two conventional treatments.”

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Reference

Bergqvist C, Mezzarobba M, Weill A, Sbidian E. Persistence of treatment with conventional systemic agents for patients with psoriasis: a real-world analysis of 73 168 new users from the French National Health Insurance database [published online November 23, 2019]. Br J Dermatol. doi: 10.1111/bjd.18734