Enos Clinton W, Ramos Vanessa L, McLean Robert R, Lin Tin-Chi, Foster Nicole, Dube Blessing, Van Voorhees Abby S
Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.
CorEvitas LLC, Waltham, MA, USA.
J Psoriasis Psoriatic Arthritis. 2023 Jan;8(1):7-10. doi: 10.1177/24755303221131257. Epub 2022 Sep 30.
Among psoriasis patients, the presence of metabolic comorbidities associates with poorer response to biologics. How the presence of comorbidity impacts treatment patterns with biologics is not fully understood.
Adult patients in the CorEvitas Psoriasis Registry were included if they initiated biologic therapy between 5/2015-12/2019 and had a 6-month follow-up visit. The frequency of biologic discontinuations by 6-months were calculated by metabolic comorbidity status (current obesity and histories of hypertension [HTN], diabetes [DM], and hyperlipidemia [HLD]) for all patients and by drug class (tumor necrosis factor inhibitors [TNFi], interleukin-17i [IL-17i], and IL-23i or IL-12/23i).
Among the 2924 participants, discontinuations were more frequent in those with obesity (17%, < .01) or DM (20%, < .001) compared to those without these (13% and 14%, respectively). Discontinuations were similar for those with and without histories of HTN or HLD. Frequencies of discontinuation for each biologic class were: TNFi (26%), IL-17i (16%), and IL-23i or IL-12/23i (9%). Among TNFi initiators, the proportions of discontinuations were greater in the presence of obesity (30%, < .05), DM (34%, < .05), or HTN (34%, < .01) compared to those without (22%, 24%, and 22%, respectively). Of the IL-23i or IL-12/23i initiators, discontinuations were more frequent in those with obesity (11%, < .01) or with DM (13%, < .05) compared to those without (7% and 8%, respectively). Discontinuations did not statistically differ between comorbidity groups in IL-17i initiators.
Comorbid disease status, especially obesity and DM, should be assessed at biologic initiation as it may predict a less optimal clinical outcome.
在银屑病患者中，代谢合并症的存在与对生物制剂的反应较差相关。合并症的存在如何影响生物制剂的治疗模式尚不完全清楚。
纳入CorEvitas银屑病登记处的成年患者，这些患者在2015年5月至2019年12月期间开始生物治疗，并进行了6个月的随访。计算所有患者按代谢合并症状态（当前肥胖以及高血压[HTN]、糖尿病[DM]和高脂血症[HLD]病史）以及按药物类别（肿瘤坏死因子抑制剂[TNFi]、白细胞介素-17抑制剂[IL-17i]和IL-23抑制剂或IL-12/23抑制剂）在6个月时生物制剂停药的频率。
在2924名参与者中，与无肥胖（分别为13%和14%）或糖尿病（分别为13%和14%）的参与者相比，肥胖者（17%，P<0.01）或糖尿病患者（20%，P<0.001）停药更为频繁。有和无高血压或高脂血症病史的参与者停药情况相似。每种生物制剂类别的停药频率分别为：TNFi（26%）、IL-17i（16%）和IL-23抑制剂或IL-12/23抑制剂（9%）。在TNFi起始治疗者中，与无肥胖（分别为22%、24%和22%）、糖尿病（分别为22%、24%和22%）或高血压（分别为22%、24%和22%）的参与者相比，存在肥胖（30%，P<0.05）、糖尿病（34%，P<0.05）或高血压（34%，P<0.01）时停药比例更高。在IL-23抑制剂或IL-12/23抑制剂起始治疗者中，与无肥胖（分别为7%和8%）或糖尿病（分别为7%和8%）的参与者相比，肥胖者（分别为11%，P<0.01）或糖尿病患者（分别为13%，P<0.05）停药更为频繁。在IL-17i起始治疗者中，合并症组之间停药情况无统计学差异。
在开始使用生物制剂时应评估合并症状态，尤其是肥胖和糖尿病，因为这可能预示临床结局欠佳。
