Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, UPEC, Créteil, France.
INSERM, Centre d'Investigation Clinique 1430, Créteil, France.
J Eur Acad Dermatol Venereol. 2017 Dec;31(12):2046-2054. doi: 10.1111/jdv.14406. Epub 2017 Jul 16.
Decision-making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis.
Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified as follows: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion.
The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (±SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept (n = 247, 29.8%), ustekinumab (n = 194, 23.4%) and infliximab (n = 34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept (aOR, 0.42; 95% CI, 0.16-1.07) and ustekinumab (aOR, 0.15; 95% CI, 0.04-0.52). Patients were significantly more likely to receive ustekinumab (aOR, 2.39; 95% CI, 1.04-5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favour of etanercept prescription in patients with cardiovascular comorbidities, metabolic syndrome and in patients with a history of cancer.
We identified patient- and disease-related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis.
决策是一个复杂的过程。我们的研究目的是评估与中度至重度银屑病患者首次生物治疗选择相关的因素。
分析了 2012 年 7 月至 2016 年 7 月期间所有纳入法国前瞻性、观察性、队列、Psobioteq 并首次开具生物制剂处方的患者的数据。招募中心的皮肤科医生在常规临床评估中通过标准化病例报告表收集人口统计学信息和临床特征。主要结局是首次生物治疗的性质。根据纳入年份的调整多变量逻辑回归模型，确定了以下四个组：阿达木单抗组、依那西普组、乌司奴单抗组和英夫利昔单抗组。
研究人群包括 830 名首次接受生物制剂治疗的生物初治患者。平均年龄为 46.6±13.9 岁，318 名患者（38.3%）为女性。最常开的生物制剂是阿达木单抗：355 名患者（42.8%），其次是依那西普（n=247，29.8%）、乌司奴单抗（n=194，23.4%）和英夫利昔单抗（n=34，4.0%）。在多变量逻辑回归分析中，与依那西普（优势比，0.42；95%置信区间，0.16-1.07）和乌司奴单抗（优势比，0.15；95%置信区间，0.04-0.52）相比，基线 PASI 或患有银屑病关节炎的患者更有可能接受阿达木单抗治疗。与阿达木单抗相比，如果患者有潜伏性结核筛查阳性，则更有可能接受乌司奴单抗治疗（优势比，2.39；95%置信区间，1.04-5.50）。年轻患者也更有可能接受乌司奴单抗治疗。与阿达木单抗相比，患有慢性阻塞性肺疾病的患者更有可能被处方乌司奴单抗或依那西普。在有心血管合并症、代谢综合征和癌症病史的患者中，使用依那西普的趋势更为明显。
我们确定了与患者和疾病相关的因素，这些因素对临床实践中首次生物制剂的选择有重要影响。临床医生在选择银屑病生物制剂时似乎对患者特征有整体的认识。
