Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Dermatol. 2021 Sep;38(5):1169-1177. doi: 10.1111/pde.14781. Epub 2021 Aug 31.
BACKGROUND/OBJECTIVES: Systemic medications and phototherapy are used to treat pediatric psoriasis, but real-world data on treatment utilization and persistence are limited. The study objective was to determine systemic and phototherapy treatment utilization and compare drug survival among systemics in pediatric psoriasis.
Using United States commercial insurance claims data, a cross-sectional analysis was conducted to describe the prevalence of systemic treatment and phototherapy use among patients <18 years old with psoriasis. We compared drug survival among new users of methotrexate, adalimumab, etanercept, and ustekinumab using a retrospective cohort design.
Among 13 759 patients, 14.6% used systemic or phototherapy treatment during 2001-2016, with rising utilization of systemics over this period. Among 579 new users of methotrexate, adalimumab, etanercept, and ustekinumab, the median durations of the initial treatment course were 141 (IQR 59-314), 179 (79-339), 175 (90-419), and 216 (64-435) days, respectively (P = .04). Drug discontinuation was less likely among ustekinumab (HR 0.47 [95% CI 0.27-0.83]), etanercept (0.74 [0.59-0.92]), and adalimumab (0.75 [0.55-1.02]) initiators than methotrexate initiators after adjustment for sociodemographic factors and psoriatic arthritis. Drug survival differences were limited to systemic-naïve patients. Potential limitations include short follow-up and residual confounding.
Utilization of systemic therapies for pediatric psoriasis is increasing, but differences in drug survival exist.
背景/目的：全身性药物和光疗用于治疗儿童银屑病，但关于治疗利用和持久性的真实世界数据有限。本研究的目的是确定儿童银屑病中全身性药物和光疗的治疗利用情况，并比较不同全身性药物的药物存活率。
使用美国商业保险索赔数据，通过横断面分析描述了 2001-2016 年期间，年龄<18 岁的银屑病患者中全身性治疗和光疗的使用情况。我们使用回顾性队列设计比较了甲氨蝶呤、阿达木单抗、依那西普和乌司奴单抗新使用者的药物存活率。
在 13759 名患者中，14.6%的患者在 2001-2016 年期间使用了全身性或光疗治疗，在此期间全身性药物的使用率不断上升。在 579 名新使用甲氨蝶呤、阿达木单抗、依那西普和乌司奴单抗的患者中，初始治疗疗程的中位数分别为 141（IQR 59-314）、179（79-339）、175（90-419）和 216（64-435）天（P=0.04）。在调整了社会人口统计学因素和银屑病关节炎后，乌司奴单抗（HR 0.47[95%CI 0.27-0.83]）、依那西普（0.74[0.59-0.92]）和阿达木单抗（0.75[0.55-1.02]）的停药率低于甲氨蝶呤的停药率。药物生存差异仅限于全身性药物初治患者。潜在的局限性包括随访时间短和残留混杂因素。
儿童银屑病全身性药物的使用率正在增加，但药物存活率存在差异。
