Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Quality Measurements and Research, Clalit Health Services, Tel-Aviv, Israel.
J Eur Acad Dermatol Venereol. 2018 Feb;32(2):245-253. doi: 10.1111/jdv.14583. Epub 2017 Oct 17.
Biologics have greatly improved psoriasis management. However, primary and secondary non-response to treatment requires innovative strategies to optimize outcomes.
To describe the use of combined treatment of biologics with conventional systemic agents or phototherapy in daily clinical practice.
We collected data on frequency of use, demographics, treatment characteristics and drug survival of biologics combined with conventional systemic agents or phototherapy in five PSONET registries.
Of 9922 biologic treatment cycles, 982 (9.9%) were identified as combination treatment. 72.9% of treatment cycles concerned concomitant use of methotrexate, 25.3% concerned concomitant UVB therapy, acitretin or cyclosporin and 1.8% concerned combined treatment with PUVA, fumaric acids or a second biologic. Substantial variation was detected in type and frequency of combination treatments prescribed across registries. Patients initiated on combined treatment had generally severe disease and were affected with psoriasis for many years. The extent to which patients had been priory treated with biologic monotherapy and the proportion of patients affected with psoriatic arthritis differed between registries. Survival rates for etanercept, adalimumab, infliximab and ustekinumab with methotrexate ranged between 43 and 92%, 28 and 83%, 65 and 87% and 53 and 77%, respectively, across registries after one year with no consistent superior survival for a particular biologic. Longest survival on a biologic combined with methotrexate, acitretin or cyclosporin was 103, 78 and 34 months, respectively.
Methotrexate was the most commonly used concomitant treatment for patients on a biologic. Wide geographical variations in treatment selection and persistence of combination treatment exist. Data derived from ongoing studies may help to determine whether combined treatment is superior to biologic monotherapy.
生物制剂极大地改善了银屑病的治疗效果。然而，治疗的原发性和继发性无应答需要创新的策略来优化治疗效果。
描述在日常临床实践中联合使用生物制剂与传统全身药物或光疗的情况。
我们收集了五个 PSONET 登记处中生物制剂联合传统全身药物或光疗的使用频率、人口统计学、治疗特征和药物生存数据。
在 9922 个生物制剂治疗周期中，有 982 个（9.9%）被确定为联合治疗。72.9%的治疗周期涉及甲氨蝶呤的同时使用，25.3%涉及同时使用 UVB 治疗、阿维 A 或环孢素，1.8%涉及联合使用 PUVA、富马酸或第二种生物制剂。在不同的登记处之间，联合治疗的类型和频率存在显著差异。开始接受联合治疗的患者通常病情严重，且患有银屑病多年。在登记处之间，接受生物制剂单药治疗的患者比例和患有银屑病关节炎的患者比例也存在差异。在使用甲氨蝶呤时，依那西普、阿达木单抗、英夫利昔单抗和乌司奴单抗的 1 年生存率分别为 43%至 92%、28%至 83%、65%至 87%和 53%至 77%，在不同的登记处之间没有特定生物制剂的生存率始终更高。在联合使用甲氨蝶呤、阿维 A 或环孢素时，最长的生物制剂生存时间分别为 103、78 和 34 个月。
甲氨蝶呤是生物制剂患者最常用的联合治疗药物。在治疗选择和联合治疗的持续存在方面存在广泛的地域差异。来自正在进行的研究的数据可能有助于确定联合治疗是否优于生物制剂单药治疗。
