A Comparison of Psoriasis Drug Failure Rates and Reasons for Discontinuation in Biologics vs Conventional Systemic Therapies
July 2014 | Volume 13 | Issue 7 | Original Article | 848 | Copyright © July 2014
Adriane A. Levin BA,a,b Alice B. Gottlieb MD PhD,b,c and Shiu-chung Au MDb
aBoston University School of Medicine, Boston, MA
bDepartment of Dermatology, Tufts Medical Center, Boston, MA
cTufts University School of Medicine, Boston, MA
DESIGN: Retrospective, cross-sectional.
METHODS: All patient visits coded for psoriasis (ICD-0 696.1) in the clinical practice of 2 dermatologists from January 1 2008 through January 4 2012 were included in this retrospective data analysis. 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 or traditional systemic. Treatment failure was defined as discontinuation of treatment course for any reason. Patient time to failure for each therapy was calculated, as were previous treatments and reasons for treatment discontinuation.
RESULTS: One hundred and fifty-nine patients who underwent 284 courses of treatment were studied. Forty-eight percent of biologics failed in an average of 242 days, compared with 75% of traditional systemics (P<.0001), which failed in an average of 143 days (P<.0001). Infliximab had the longest survival time (292 days), and ustekinumab had the smallest failure rate (39%). Reasons for discontinuation differed significantly between biologics and systemics, with biologics being discontinued more often due to loss of efficacy (P=.0014), and systemics failing significantly more frequently due to adverse events (P<.001). Adverse events were observed most frequently with methotrexate and infliximab, while golimumab had the highest rates of both loss and lack of efficacy.
CONCLUSION: Biologics had longer survival times and lower failure rates than traditional systemics in the treatment of psoriasis. Biologics were more likely to be discontinued due to loss of efficacy, and systemics were more likely to fail due to adverse events.
J Drugs Dermatol. 2014;13(7):848-853.