Blauvelt Andrew, McLean Robert R, Beaty Silky W, Sima Adam P, Low Robert, Stark Jeffrey L, McClung Laura, Bagel Jerry
Oregon Medical Research Center, 9495 SW Locust Street, Suite G, Portland, OR, 97223, USA.
CorEvitas, LLC, Waltham, MA, USA.
Dermatol Ther (Heidelb). 2024 Oct;14(10):2787-2804. doi: 10.1007/s13555-024-01257-2. Epub 2024 Sep 16.
Due to variable psoriasis symptoms, disease progression, and individual responses to therapy, patients may start, stop, or switch biologic therapies. Real-world data on the associated disease burden of patients with psoriasis who do and do not switch biologics are incomplete.
This study compared disease burden among patients from the CorEvitas Psoriasis Registry (July 2017-December 2021) who switched biologics and those who did not within 4-12 months following initiation. Disease-related patient-reported outcomes (PROs) were recorded, including skin pain, itching, activity impairment, and effects on health-related quality of life (HRQoL). Disease severity was measured by body surface area (BSA) and Psoriasis Area and Severity Index (PASI). Unadjusted and adjusted regression models were used to compare study outcome measures between the two groups.
This study included 2145 patients, with 159 classified as switchers and 1986 as non-switchers. The most common reason for switching therapy was failure to maintain initial response (51.7%; n = 78). Moderate-to-severe disease (BSA ≥ 3) was found among 83.0% (n = 132) of switchers versus 26.1% (n = 516) of non-switchers. PASI > 5 was reported among 49.7% (n = 79) of switchers versus 8.6% (n = 171) of non-switchers. Differences in skin pain, itching, and effects on HRQoL between switchers and non-switchers were larger in magnitude for bio-experienced patients.
Patients who switched biologic therapy experienced a greater disease burden of psoriasis across PROs than non-switchers. Patient-centered factors may be important drivers of biologic switching. Our findings suggest the association between switching and disease burden may be stronger among patients with prior biologic therapy experience.
由于银屑病症状、疾病进展以及个体对治疗的反应各不相同，患者可能开始、停止或更换生物制剂疗法。关于更换和未更换生物制剂的银屑病患者相关疾病负担的真实世界数据并不完整。
本研究比较了CorEvitas银屑病登记处（2017年7月至2021年12月）中在开始治疗后4至12个月内更换生物制剂的患者与未更换生物制剂的患者之间的疾病负担。记录了与疾病相关的患者报告结局（PROs），包括皮肤疼痛、瘙痒、活动受限以及对健康相关生活质量（HRQoL）的影响。通过体表面积（BSA）和银屑病面积和严重程度指数（PASI）来衡量疾病严重程度。使用未调整和调整后的回归模型比较两组之间的研究结局指标。
本研究纳入了2145例患者，其中159例为更换治疗者，1986例为未更换治疗者。更换治疗的最常见原因是未能维持初始反应（51.7%；n = 78）。83.0%（n = 132）的更换治疗者患有中度至重度疾病（BSA≥3），而未更换治疗者中这一比例为26.1%（n = 516）。49.7%（n = 79）的更换治疗者报告PASI>5，而未更换治疗者中这一比例为8.6%（n = 171）。对于有生物制剂治疗经验的患者，更换治疗者和未更换治疗者在皮肤疼痛、瘙痒以及对HRQoL的影响方面的差异幅度更大。
与未更换生物制剂的患者相比，更换生物制剂治疗的患者在各项PROs方面经历的银屑病疾病负担更大。以患者为中心的因素可能是生物制剂更换的重要驱动因素。我们的研究结果表明，在有生物制剂治疗经验的患者中，更换治疗与疾病负担之间的关联可能更强。
