Bonomo Lauren, Abittan Brian J., Hashim Peter W., Karki Chitra, Mason Marc, Lebwohl Mark
J Drugs Dermatol. 2019 Aug 1;18(8):731-740.
There are increasing options for systemic combination therapy for psoriasis but a lack of literature around the characteristics of patients who are started on these regimens. OBJECTIVE: We aimed to determine how combination systemic therapy patients differ from monotherapy patients in their social, medical, or treatment history. DESIGN: This was a cross-sectional study of patients enrolled in the Corrona Psoriasis Registry. Descriptive characteristics were compared in biologic monotherapy and combination therapy groups. SETTING: The Corrona PsO registry is a prospective multicenter observational disease-based registry with patients recruited from 154 private and academic practice sites in the US and Canada with 373 participating dermatologists. PARTICIPANTS: Patients 18 years of age or older who enrolled in the Corrona Psoriasis Registry between April 2015 and March 2017 and initiated an eligible biologic therapy at the time of enrollment were included. EXPOSURES: Eligible biologic therapies included adalimumab, etanercept, infliximab, ixekizumab, secukinumab, and ustekinumab. Non-biologic and small molecule adjunctive therapies included acitretin, apremilast, CsA, and MTX. RESULTS: Patients on combination therapy were more likely to identify as black, to have Medicaid, and to report disabled work status. While combination therapy patients were more likely to have concomitant PsA, no major differences were seen in disease morphology, duration, IGA, PASI, or BSA affected at treatment initiation. CONCLUSIONS: Various demographic and socioeconomic factors are associated with use of combination systemic therapy compared to use of systemic monotherapy for psoriasis. An association with commonly used disease severity indices was not observed. RELEVANCE: An understanding of which patients are more likely to be prescribed combination systemic therapy will provide important context for long-term efficacy and safety data as they become available.
银屑病的全身联合治疗选择日益增多，但关于开始使用这些治疗方案的患者特征的文献却很匮乏。目的：我们旨在确定联合全身治疗的患者与单药治疗的患者在社会、医疗或治疗史方面有何不同。设计：这是一项对参与科罗纳银屑病注册研究的患者进行的横断面研究。对生物单药治疗组和联合治疗组的描述性特征进行了比较。背景：科罗纳银屑病注册研究是一项基于疾病的前瞻性多中心观察性注册研究，患者来自美国和加拿大的154个私立和学术医疗机构，有373名皮肤科医生参与。参与者：纳入2015年4月至2017年3月期间加入科罗纳银屑病注册研究且在入组时开始使用符合条件的生物治疗的18岁及以上患者。暴露因素：符合条件的生物治疗包括阿达木单抗、依那西普、英夫利昔单抗、司库奇尤单抗、苏金单抗和乌司奴单抗。非生物和小分子辅助治疗包括阿维A、阿普米司特、环孢素和甲氨蝶呤。结果：接受联合治疗的患者更有可能为黑人、有医疗补助且报告工作状态为残疾。虽然联合治疗的患者更有可能伴有银屑病关节炎，但在疾病形态、病程、初始治疗时的医师全面评估（IGA）、银屑病面积和严重程度指数（PASI）或受累体表面积（BSA）方面未发现重大差异。结论：与银屑病全身单药治疗相比，多种人口统计学和社会经济因素与全身联合治疗的使用相关。未观察到与常用疾病严重程度指标的关联。相关性：了解哪些患者更有可能被处方全身联合治疗将为长期疗效和安全性数据提供重要背景，因为这些数据即将可得。
