Adherence to Ustekinumab in Psoriasis Patients
October 2013 | Volume 12 | Issue 10 | Original Article | 1090 | Copyright © October 2013
Laura F. Sandoval DO,a Karen E. Huang MS,a and Steven R. Feldman MD PhDa,b,c
aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
cPublic Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
BACKGROUND: Adherence to the treatment of psoriasis is poor and effects treatment outcomes. Literature on adherence to biologic therapy for the treatment of psoriasis is limited and difficult to measure. However, ustekinumab, which until recently was only approved to be administered in office, offers an opportunity to assess adherence through chart review.
PURPOSE: The purpose of this study is to determine adherence rates and reasons for nonadherence to ustekinumab in the treatment of psoriasis.
METHODS: This was a single center, retrospective study involving a chart review of patients with a diagnosis of psoriasis and administration of ustekinumab seen at one clinic between October 1, 2009 and June 1, 2013. We assessed the number of injections administered, the time between injections, and reasons for nonadherence.
RESULTS: 45 patients received ustekinumab for the treatment of psoriasis. The median time between doses of ustekinumab (n=164) was 13 weeks (91 days, interquartile range 89, 98). For patients that received at least 3 doses of ustekinumab, overall median adherence was 100% (IQR 66.7, 100). The median adherence to the 45 mg dose (n=26) was 100% (IQR 75, 100) and to the 90 mg dose (n=18) was 80% (IQR 60, 100; P=0.11).
LIMITATIONS: Only limited information was found on reasons for nonadherence.
Conclusions: Adherence to ustekinumab in psoriasis patients appears to be higher than reported adherence rates to topical therapies and treatment with self-administered biologics. Many factors may contribute to the greater adherence. J Drugs Dermatol.
Adherence to treatment of chronic skin diseases is important
to treatment outcomes. In the treatment of psoriasis,adherence is poor, with reported rates between 22% to 67%.1 However, adherence may be better with biologic agents, followed by oral medications, phototherapy, and then topical agents.2,3
Literature on adherence to biologics in the treatment of psoriasis
is limited; Bhosle et al reported an adherence rate of 66% with TNF-alpha inhibitors.4 Measuring adherence to biologics is difficult since traditional means of monitoring whether a patient is taking their medication cannot be utilized; there are no pills to count or bottles to weigh. In the treatment of rheumatologic diseases, where adherence to biologics has been more extensively
studied, persistence, which refers to the rate of continued drug use for a defined duration, has been the more commonly used method to measure adherence.5 This is in contrast to adherence,which refers to the extent a patient uses a medication as prescribed. Self-reported adherence rates are often used but are not reliable since patients tend to over report their adherence
in questionnaires and medication diaries.6,7 Electronic monitoring systems were used in a small study and found that adherence in the treatment of psoriasis patients with adalimumab was variable and in some cases poor. Patients averaged 19.8 days between injections that were scheduled every 14 days in the non-intervention group, and 20.7 days in the intervention
group, with the number of days between doses varying between 6 and 93.8
Ustekinumab is an interleukin (IL)-12 and IL-23 blocker administered
by office injection (the FDA has recently approved ustekinumab to be self-administered, like the injectable TNF-α inhibitors) and approved for the treatment of psoriasis. Dosing is weight based, 45 mg and 90 mg (recommended for patients > 100 kg), administered as a loading dose 1 month after initial injection, with subsequent doses every 12 weeks.9 As ustekinumab
has been administered in the office setting, adherence to ustekinumab can be determined by chart review. The goal of this study is to describe adherence rates to ustekinumab in psoriasis patients, including the number of injections administered, the time between injections, and reasons for nonadherence.
This was a single center, retrospective study involving a chart review of patients with a diagnosis of psoriasis and administration
of ustekinumab seen at the Wake Forest School of Medicine Department of Dermatology clinic between October 1, 2009 and June 1, 2013. Approval for this study was obtained from Wake