Real-world effectiveness of methotrexate, ciclosporin, acitretin and fumaric acid esters for psoriasis: Does treatment history matter?

Mason, Kayleigh J.

Abstract

Background: Real-world effectiveness of the systemic therapies methotrexate (MTX), ciclosporin (CsA), acitretin (ACI) and fumaric acid esters (FAE) prescribed to patients with moderate–severe psoriasis is poorly characterized.

Objectives: To determine whether systemic treatment history predicts the effectiveness of ACI, CsA, FAE and MTX.

Methods: The British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) is a pharmacovigilance register investigating the long-term safety of systemic therapies prescribed to psoriasis patients. Established in 2007, over 15,500 patients have been recruited from 160 dermatology centres across the UK and Ireland. Patients registering on MTX, CsA, ACI or FAE with at least 6 months follow-up were analyzed. Exposure time for the registration therapy was calculated from initiation to censor at: discontinuation date; latest follow-up; or death. Effectiveness was defined as achieving Psoriasis Area and Severity Index (PASI) ≤3 using the first longitudinal PASI reported after initiating therapy. Treatment history was classified into incident (first systemic), prevalent (prescribed registration therapy previously), or previous systemic use (prescribed another systemic therapy previously). Multivariable logistic regression estimated the odds ratio (OR) of achieving PASI≤3 with a priori baseline covariates included. Missing data were accounted for using a multiple imputation model of 20 datasets.

Results: In total, of 4113 patients analyzed, 1991 (48%) were prescribed MTX, 1022 (25%) CsA, 765 (19%) ACI and 335 (8%) FAE. The proportions of incident, prevalent and previous systemic users, respectively, were similar for MTX (41%; 18%; 41%), CsA (38%; 16%; 46%) and ACI (42%; 16%; 42%), but differed for FAE (19%; 15% 66%). The proportion of patients achieving PASI≤3 were 31% MTX, 36% CsA, 22% ACI and 26% FAE. Prevalent users of ACI (OR 0.67, 95% confidence interval [CI] 0.45–0.99) and CsA (0.64, 0.47–0.87) were less likely to achieve PASI≤3 compared with incident users. Prevalent users of MTX (0.81, 0.64–1.02) and FAE (0.66, 0.33–1.31), and previous systemic users did not differ significantly to incident users in achieving PASI≤3.

Conclusions: The effectiveness of MTX and FAE does not appear to differ by treatment history categories and could be prescribed as first or subsequent lines of therapy. Prevalent users of CsA and ACI registering on those therapies were less likely to achieve PASI≤3 compared to incident users. The findings for CsA may reflect the intermittent short-term use in clinical practice.

Citation

Mason, K. J. (2019, August). Real-world effectiveness of methotrexate, ciclosporin, acitretin and fumaric acid esters for psoriasis: Does treatment history matter?. Poster presented at 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Pennsylvania Convention Center, Philadelphia, PA, USA

• Presentation Conference Type: Poster
• Conference Name: 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management
• Conference Location: Pennsylvania Convention Center, Philadelphia, PA, USA
• Start Date: Aug 24, 2019
• End Date: Aug 28, 2019
• Deposit Date: Jun 27, 2023
• DOI: https://doi.org/10.1002/pds.4864
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/pds.4864