Faculty of Medicine & Dentistry, University of Alberta Medical School, Edmonton, AB, Canada.
Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada.
Br J Dermatol. 2019 Sep;181(3):450-458. doi: 10.1111/bjd.17738. Epub 2019 Apr 29.
Long-term therapy for psoriasis is impaired by gradual loss of effectiveness and treatment discontinuation. Identifying factors that affect biologic drug survival may help in treatment optimization.
To identify factors that predicted biologic drug persistence or discontinuation in a real-life setting.
We identified studies of biologic persistence in psoriasis through a comprehensive, systematic literature search using predefined search criteria. Studies were screened by title and abstract then further by full-text review. Hazard ratio (HR) data were extracted for all available predictive factors (HRs > 1 denoted biologic discontinuation, and HRs < 1 denoted biologic persistence). A meta-analysis of HRs (random-effects model) was used to assess any predictive factor included in at least two studies.
Sixteen cohort studies were included in the review, with a total of 32 194 patients. A meta-analysis was performed on 13 studies (n = 29 802): nine for female sex (n = 28 090), six for obesity (n = 9311) and six for psoriatic arthritis (n = 24 444). Obesity and female sex predicted treatment discontinuation, with HRs of 1.21 [95% confidence interval (CI) 1.10-1.32, I = 0%] and 1.22 (95% CI 1.07-1.38, I = 84%), respectively. Concomitant psoriatic arthritis predicted biologic persistence (HR 0.83, 95% CI 0.80-0.86, I = 0%). Female sex predicted biologic discontinuation due to side-effects, with a pooled HR of 2.16 (95% CI 1.39-3.35, I = 67%). Other reported predictive factors (smoking, metabolic syndrome, biologic naivety, age, Dermatology Life Quality Index, dyslipidaemia, high socioeconomic status and concomitant methotrexate) were insufficiently reported for meta-analysis.
Our meta-analysis demonstrates that female sex and obesity predict biologic discontinuation, and concomitant psoriatic arthritis predicts biologic survival. What's already known about this topic? Ineffectiveness is the main factor that causes drug discontinuation during long-term treatment of psoriasis. It is unclear which factors and comorbidities impact drug persistence. What does this study add? Female sex and obesity predict biologic discontinuation due to ineffectiveness and adverse events. Concomitant psoriatic arthritis is associated with improved drug persistence.
银屑病的长期治疗因疗效逐渐下降和治疗中断而受到影响。确定影响生物药物存活的因素有助于优化治疗。
在真实环境中确定预测生物药物持久性或停药的因素。
我们通过使用预定义的搜索标准进行全面、系统的文献搜索，确定了生物药物持久性的研究。通过标题和摘要筛选研究，然后通过全文审查进一步筛选。为所有可用的预测因素（HR > 1 表示生物药物停药，HR < 1 表示生物药物持续）提取风险比（HR）数据。使用 HR 的荟萃分析（随机效应模型）评估至少包含在两项研究中的任何预测因素。
综述共纳入 16 项队列研究，共 32194 例患者。对 13 项研究（n = 29802）进行了荟萃分析：9 项研究为女性（n = 28090），6 项研究为肥胖（n = 9311），6 项研究为银屑病关节炎（n = 24444）。肥胖和女性预测治疗中断，风险比分别为 1.21（95%置信区间 1.10-1.32，I = 0%）和 1.22（95%置信区间 1.07-1.38，I = 84%）。同时患有银屑病关节炎预测生物药物持续存在，风险比为 0.83（95%置信区间 0.80-0.86，I = 0%）。女性因副作用预测生物药物停药，汇总风险比为 2.16（95%置信区间 1.39-3.35，I = 67%）。其他报告的预测因素（吸烟、代谢综合征、生物药物初治、年龄、皮肤病生活质量指数、血脂异常、高社会经济地位和同时使用甲氨蝶呤）报告不足，无法进行荟萃分析。
我们的荟萃分析表明，女性和肥胖预测生物药物停药，同时患有银屑病关节炎预测生物药物存活。
