Real-world persistence and effectiveness of conventional systemic therapies in the treatment of psoriasis: A systematic review

Williams, Sophie; Mason, Kayleigh J.; Yiu, Zenas; McElhone, Kathleen; Warren, Richard B.; Griffiths, Christopher E.M.

Abstract

Background: The effectiveness and persistence of biologic therapies is better understood than more commonly prescribed conventional systemic therapies in clinical practice.

Objectives: To evaluate large-scale observational studies investigating the persistence and effectiveness of acitretin (AC), ciclosporin (CIC), fumaric acid esters (FAE) or methotrexate (MTX) in ≥100 adult patients with moderate-severe psoriasis, exposed to therapy for ≥3 months.

Methods: A literature search was conducted using Medline, Embase, the Cochrane Library and PubMed. Outcomes of interest were persistence (therapy duration or the proportion of patients discontinuing therapy) and effectiveness (improvements in Psoriasis Area and Severity Index [PASI] or Physician Global Assessment [PGA] at 3, 6, or 12 months), including patients who achieved a reduction of ≥75% in their PASI score from baseline (PASI75). Study characteristics and results were extracted and the risk of bias was assessed using the Cochrane tool.

Results: Of the ten articles reviewed, the risk of bias was high in seven and medium in three; therefore, a meta-analysis was not conducted. Persistence: Three studies investigated AC, CIC and MTX; the first study investigated FAE and MTX, whilst the second and third studies investigated FAE and MTX only. Two of the 3 studies investigating AC, CIC and MTX reported median durations of 0.7, 0.4, and 1.0 years, and 0.5, 0.5, and 1.0 years, respectively. The third study only reported a mean duration of 20 weeks exposure to MTX. The study investigating FAE and MTX reported 69% and 74% patients discontinued during follow-up, respectively. The remaining studies reported mean durations of 28 and 50 months for FAE and 1 year for MTX, with 2 studies reporting median MTX durations of 7.7 and 17.2 months. Effectiveness: Three studies reported 76% (FAE), 53% (MTX) and 59% (MTX) patients achieving PASI 75 at 12 months, with 1 study reporting 76% FAE-exposed patients with markedly improved/clear PGA at 12 months. No studies investigating the effectiveness of AC or CIC were identified.

Conclusions: Few data were available for AC and CIC, and the time to discontinuation was generally not provided. This review highlights the need for registry-based studies to explore the real-world persistence and effectiveness of conventional systemic treatments in clinical practice.

Citation

Williams, S., Mason, K. J., Yiu, Z., McElhone, K., Warren, R. B., & Griffiths, C. E. (2018, August). Real-world persistence and effectiveness of conventional systemic therapies in the treatment of psoriasis: A systematic review. Paper presented at 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague Congress Centre, Prague, Czech Republic

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management
• Conference Location: Prague Congress Centre, Prague, Czech Republic
• Start Date: Aug 22, 2018
• End Date: Aug 26, 2018
• Deposit Date: Jun 27, 2023
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/pds.4629