Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
J Dermatolog Treat. 2024 Dec;35(1):2398170. doi: 10.1080/09546634.2024.2398170. Epub 2024 Sep 4.
The advent of biosimilars may increase the frequency of dose escalation with biologics in psoriasis.
To explore the frequency and outcomes of dose escalation with adalimumab etanercept, and ustekinumab.
Data were extracted from DermaReg-Pso, a psoriasis register in Stockholm, Sweden. The main exposure was treatment, and the main outcome was dose escalation. We describe outcomes with dose escalation by estimating drug survival and changes in the Psoriasis Area and Severity Index (PASI).
554 patients had 946 treatment episodes with adalimumab, etanercept, or ustekinumab. The cumulative incidence of dose escalation was 4.1 per 100 treatment years. The Hazard Ratios (HRs) for dose escalation with ustekinumab vs adalimumab and ustekinumab vs etanercept were 1.93 (95% CI: 1.25-2.98), and 2.20 (95% CI: 1.42-3.41), respectively. After dose escalation, the HRs for treatment discontinuation with adalimumab and etanercept compared with ustekinumab were 3.10 (95% CI: 1.56-6.18) and 7.15 (95% CI: 3.96-12.94), respectively. PASI was higher after compared to before dose escalation for etanercept ( = 0.036), but not for adalimumab ( = 0.832) or ustekinumab ( = 0.300).
Dose escalation was comparatively more frequent with ustekinumab than with adalimumab or etanercept; however, treatment discontinuation after dose escalation was more common with adalimumab and etanercept than ustekinumab.
生物类似药的出现可能会增加银屑病患者生物制剂的剂量升级频率。
探索阿达木单抗、依那西普和乌司奴单抗的剂量升级频率和结果。
数据来自瑞典斯德哥尔摩的银屑病登记处 DermaReg-Pso。主要暴露因素为治疗，主要结局为剂量升级。我们通过估计药物生存率和银屑病面积和严重程度指数（PASI）的变化来描述剂量升级的结果。
554 例患者有 946 次阿达木单抗、依那西普或乌司奴单抗治疗。剂量升级的累积发生率为每 100 个治疗年 4.1 例。与阿达木单抗相比，乌司奴单抗和依那西普剂量升级的风险比（HR）分别为 1.93（95%CI：1.25-2.98）和 2.20（95%CI：1.42-3.41）。剂量升级后，与乌司奴单抗相比，阿达木单抗和依那西普停药的 HR 分别为 3.10（95%CI：1.56-6.18）和 7.15（95%CI：3.96-12.94）。与剂量升级前相比，依那西普的 PASI 更高（=0.036），但阿达木单抗（=0.832）和乌司奴单抗（=0.300）则没有。
与阿达木单抗和依那西普相比，乌司奴单抗的剂量升级更为频繁；然而，与乌司奴单抗相比，阿达木单抗和依那西普在剂量升级后停药更为常见。
