Comparison of the Efficacy of Biologics Versus Conventional Systemic Therapies in the Treatment of Psoriasis at a Comprehensive Psoriasis Care Center
August 2013 | Volume 12 | Issue 8 | Original Article | 861 | Copyright © 2013
Shiu-chung Au MD,a Abdulaziz Madani MD,a Marwan Alhaddad MD,a Maha Alkofide MD,a and Alice B. Gottlieb MD PhDa,b
aDepartment of Dermatology, Tufts Medical Center, Boston, MA
bTufts University School of Medicine, Boston, MA
BACKGROUND: The efficacy of biologic treatment for psoriasis has not been compared to that of conventional systemic therapies and phototherapy outside of clinical trial settings.
DESIGN: Retrospective, cross-sectional
METHODS: All patient visits with a code for psoriasis (ICD-9 696.1) in the clinical practice of two dermatologists with a high percentage (over 70% of chief complaints) of psoriasis patients from Jan 1, 2008 to Jan 4, 2012 inclusive were included in this retrospective data analysis. Patients were excluded if the baseline Physician's Global Assessment (PGA) at start of treatment was unknown, or less than 3 (moderate). The practice is a comprehensive psoriasis care center in the Northeastern United States serving a metropolitan population of over 4 million people. Patients were divided by treatment type (biologic, conventional systemic or both) and history of previous treatments. Patients were evaluated by Body Surface Area (BSA), PGA, Simple-Measure for Assessing Psoriasis Activity (S-MAPA, calculated by BSA multiplied by PGA). Patients were evaluated at baseline, 8, 12, 16, and 24 weeks after start of treatment. Patients must have completed at least 8 weeks on a single treatment in order to be included.
RESULTS: 46 courses of biologics, 12 courses of conventional systemic therapies, and 18 courses of both together were identified with PGA 3 or greater at baseline. Baseline S-MAPA for biologics was 74, for non-biologic systemics was 62.25. At week 24, S-MAPA improved 70.2% over baseline in patients treated with biologics, patients treated with non-biologic systemics improved by only 40.4% (P<0.05). The average number of prior treatments for patients on biologics was 1.87 versus 1.25 for patients on conventional systemic therapies (P=0.169).
CONCLUSION: Biologics show superior results to conventional systemic therapies (70% improvement versus 40% improvement) for the treatment of patients with moderate to severe psoriasis, as measured by decrease in S-MAPA (PGA multiplied by BSA) at week 24. These results were observed despite the fact that patients on biologics had a greater baseline severity and had a greater number of previous treatments.
J Drugs Dermatol. 2013;12(8):861-866.
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Psoriasis is a chronic immune-mediated disorder commonly manifesting as silver-scaly plaques on an erythematous base, that has been reported at rates of up to 6.5% in certain areas of the world.1,2 Several treatment modalities for psoriasis exist including topical therapies, such as corticosteroids and vitamin D analogues, phototherapy, oral immunosuppressants and biologic therapies. However, a significant portion of patients with psoriasis are dissatisfied with their treatments, and desire better control of their disease.5
Within the last fifteen years, the US FDA has approved several immunomodulatory biologic molecules for the treatment of psoriatic arthritis and/or psoriasis. These include adalimumab, infliximab, etanercept and golimumab (Tumor Necrosis Factor (TNF)-alpha inhibitors)6-10 and ustekinumab, (targets both interleukin (IL)-12 and IL-23), Although comparator studies are few, these biologic therapies have been shown in clinical trials to have similar or superior efficacy to those reported for conventional treatment options, such as methotrexate, acitretin, cyclosporine and phototherapy.14 Patients have reported significant satisfaction with biologics.15 However, they are associated with high costs, occasional loss of efficacy with intermittent or long-term treatment, and possible rare but serious adverse effects.16 Clinical trials have validated the efficacy of biologics in psoriasis versus placebo, but only a few have compared biologics versus an active comparator.23,24 In addition, clinical trial settings do not necessarily reflect clinical practice settings, which make choosing the appropriate therapy amongst the multiple choices difficult.25
The goal of our study was to compare the efficacy of the conventional systemic treatments for psoriasis with biological treatments in a clinical setting.