Jin Joy Q, Cronin Angel, Roberts-Toler Carla, Yeroushalmi Samuel, Hadeler Edward, Spencer Riley K, Elhage Kareem G, Gondo George, Wallace Elizabeth B, Reddy Soumya M, Han George, Kaffenberger Jessica, Davis Mitchell S, Hakimi Marwa, Scher Jose U, Armstrong April W, Bhutani Tina, McLean Robert R, Liao Wilson
School of Medicine, University of California San Francisco, San Francisco, California; Department of Dermatology, University of California San Francisco, San Francisco, California.
CorEvitas, LLC., Waltham, Massachusetts.
J Am Acad Dermatol. 2023 Nov;89(5):974-983. doi: 10.1016/j.jaad.2023.06.058. Epub 2023 Jul 24.
Psoriasis patients with poor therapeutic response to multiple biologic agents are not well-characterized.
To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic.
This prospective cohort analysis evaluated patients in the multicenter CorEvitas Psoriasis Registry who initiated their first biologic between 2015 and 2020 and were followed for ≥24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued ≥2 biologics of different classes, each used for ≥90 days, due to inadequate efficacy) and GR (continued use of first biologic for ≥2 years) patients.
One thousand thirty-nine patients were analyzed (490 GR [47.2%], 65 MBF [6.3%]). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior nonbiologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter 2 variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was Tumor necrosis factor-α inhibitor to IL-17 inhibitor use.
Biologic adherence between visits was not evaluated.
Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.
对多种生物制剂治疗反应不佳的银屑病患者尚未得到充分描述。
描述与首次使用生物制剂时出现多种生物制剂治疗失败（MBF）与良好临床反应（GR）相关的特征。
这项前瞻性队列分析评估了多中心CorEvitas银屑病登记处的患者，这些患者在2015年至2020年间开始使用第一种生物制剂，并随访了≥24个月。多变量逻辑回归确定了MBF（因疗效不佳而停用≥2种不同类别的生物制剂，每种使用≥90天）和GR（持续使用第一种生物制剂≥2年）患者之间不同的社会人口统计学、临床和患者报告结局。
分析了1039例患者（490例GR [47.2%]，65例MBF [6.3%]）。女性、银屑病病程较短、生物制剂起始年份较早、既往使用过非生物制剂全身治疗、高脂血症病史和医疗补助保险与MBF显著相关，尽管后两个变量的置信区间较宽，表明支持水平较低。MBF最常观察到的第一种生物制剂到第二种生物制剂的顺序是从肿瘤坏死因子-α抑制剂到IL-17抑制剂的使用。
未评估就诊期间的生物制剂依从性。
约6%的银屑病患者符合MBF标准。结果确定了与MBF相关的特征，这些特征可能有助于区分需要更频繁随访的患者。
