Department of Dermatology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan.
Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
J Dermatol. 2023 Jun;50(6):753-765. doi: 10.1111/1346-8138.16737. Epub 2023 Feb 14.
Psoriasis affects approximately 0.3% of the Japanese population. Recently, various effective systemic drugs have become available, and the continuation of a given treatment has become critical because of the chronic nature of psoriasis. Factors affecting drug survival (the time until treatment discontinuation) in psoriasis treatment include efficacy, safety, ease of use, and patient preference. In the present study, the authors retrospectively surveyed a multifacility patient registry to determine the real-world evidence of the survival rate of systemic interventions for psoriasis treatment. Patients with psoriasis who visited 20 facilities in the Western Japan area between January 2019 and May 2020 and gave written consent were registered as study participants, and their medical history of systemic interventions for psoriasis (starting from 2010) was retrospectively collected and analyzed. The drugs investigated were adalimumab, infliximab, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, cyclosporine, and apremilast. When drugs were discontinued, the reasons were also recorded. A total of 1003 patients with psoriasis including 268 with psoriatic arthritis (PsA) were enrolled. In biologics, more recently released drugs such as interleukin 17 inhibitors showed a numerically higher survival rate in the overall (post-2010) analysis. However, in the subset of patients who began treatment after 2017, the difference in the survival rate among the drugs was smaller. The reasons for discontinuing drugs varied, but a loss of efficacy against dermatological or joint symptoms were relatively frequently seen with some biologics and cyclosporine. The stratification of drug survival rates based on patient characteristics such as bio-naive or experienced, normal weight or obese, and with or without PsA, revealed that bio-experienced, obese, and PsA groups had poorer survival rates for most drugs. No notable safety issues were identified in this study. Overall, the present study revealed that the biologics show differences in their tendency to develop a loss of efficacy, and the factors that negatively impact the survival rate of biologics include the previous use of biologics, obesity, and PsA.
银屑病影响约 0.3%的日本人。最近，各种有效的全身性药物已经问世，由于银屑病的慢性性质，继续进行特定的治疗变得至关重要。影响银屑病治疗药物生存（停药时间）的因素包括疗效、安全性、易用性和患者偏好。在本研究中，作者回顾性调查了多设施患者登记处，以确定银屑病治疗系统干预的生存率的真实世界证据。2019 年 1 月至 2020 年 5 月期间，在日本西部地区的 20 家医疗机构就诊并书面同意的银屑病患者被登记为研究参与者，回顾性收集并分析了他们的银屑病全身性干预药物史（始于 2010 年）。调查的药物包括阿达木单抗、英夫利昔单抗、乌司奴单抗、司库奇尤单抗、依奇珠单抗、布罗达单抗、古塞库单抗、瑞莎珠单抗、环孢素和阿普米司特。当药物停止使用时，也记录了原因。共纳入 1003 例银屑病患者，其中 268 例患有银屑病关节炎（PsA）。在生物制剂方面，在整体（2010 年后）分析中，最近发布的白细胞介素 17 抑制剂等药物显示出更高的生存率。然而，在 2017 年后开始治疗的患者亚组中，药物之间的生存率差异较小。停药的原因各不相同，但一些生物制剂和环孢素治疗中，皮肤或关节症状的疗效丧失相对常见。根据患者特征（如生物制剂初治或经验丰富、体重正常或肥胖、是否患有 PsA）对药物生存率进行分层，结果显示，生物制剂经验丰富、肥胖和患有 PsA 的患者，大多数药物的生存率较差。本研究未发现明显的安全问题。总的来说，本研究表明生物制剂在疗效丧失的趋势上存在差异，影响生物制剂生存率的因素包括先前使用生物制剂、肥胖和 PsA。
