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Abstract：
BACKGROUND: Plaque psoriasis is a common, often debilitating, chronic autoimmune inflammatory skin disease. Moderate-to-severe forms of psoriasis can be treated with biologics such as anti-interleukin and anti-tumor necrosis factor antibodies. We aimed to investigate treatment discontinuation among patients with psoriasis who initiated biologic treatment.
METHODS: We conducted a retrospective, non-interventional cohort study based on anonymized claims data from the German statutory health insurance which covered the years from 2016 to 2021. We included adult patients with psoriasis who initiated biologic treatment in drug-specific cohorts. Over a 365-day follow-up period, we assessed the frequencies and the time until treatment discontinuation for different biologics. Differences in discontinuation rates were compared using a multivariate Cox proportional hazards model.
RESULTS: A total of 2565 patients with psoriasis who initiated treatment with secukinumab (n = 612), adalimumab (n = 454), guselkumab (n = 354), ixekizumab (n = 259), ustekinumab (n = 241), tildrakizumab (n = 205), brodalumab (n = 166), risankizumab (n = 145), etanercept (n = 91), certolizumab (n = 29), and infliximab (n = 9) were included. A total of 1290 patients (50.29%) discontinued treatment during the follow-up period, ranging from 30.34% (risankizumab) to 69.23% (etanercept). Median time until discontinuation of treatment ranged from 102 days (etanercept) to 208 days (risankizumab). Once the biologic treatment was discontinued, 45.05% of patients restarted the treatment with the same agent, 23.10% of patients switched to another biologic, and 31.86% received no further biologic agent. Compared to patients treated with risankizumab, the treatment discontinuation rate was significantly higher (p < 0.05) in patients treated with the other biologics except ustekinumab (p = 0.12).
CONCLUSIONS: Further research should explore reasons leading to treatment discontinuation in order to support treatment choices for patients with moderate-to-severe psoriasis.
METHODS: We conducted a retrospective, non-interventional cohort study based on anonymized claims data from the German statutory health insurance which covered the years from 2016 to 2021. We included adult patients with psoriasis who initiated biologic treatment in drug-specific cohorts. Over a 365-day follow-up period, we assessed the frequencies and the time until treatment discontinuation for different biologics. Differences in discontinuation rates were compared using a multivariate Cox proportional hazards model.
RESULTS: A total of 2565 patients with psoriasis who initiated treatment with secukinumab (n = 612), adalimumab (n = 454), guselkumab (n = 354), ixekizumab (n = 259), ustekinumab (n = 241), tildrakizumab (n = 205), brodalumab (n = 166), risankizumab (n = 145), etanercept (n = 91), certolizumab (n = 29), and infliximab (n = 9) were included. A total of 1290 patients (50.29%) discontinued treatment during the follow-up period, ranging from 30.34% (risankizumab) to 69.23% (etanercept). Median time until discontinuation of treatment ranged from 102 days (etanercept) to 208 days (risankizumab). Once the biologic treatment was discontinued, 45.05% of patients restarted the treatment with the same agent, 23.10% of patients switched to another biologic, and 31.86% received no further biologic agent. Compared to patients treated with risankizumab, the treatment discontinuation rate was significantly higher (p < 0.05) in patients treated with the other biologics except ustekinumab (p = 0.12).
CONCLUSIONS: Further research should explore reasons leading to treatment discontinuation in order to support treatment choices for patients with moderate-to-severe psoriasis.
摘要：
背景：斑块型银屑病是一种常见的银屑病，经常使人衰弱，慢性自身免疫性炎症性皮肤病。可以用生物制剂如抗白介素和抗肿瘤坏死因子抗体治疗中度至重度形式的牛皮癣。我们旨在调查开始生物治疗的牛皮癣患者的治疗中断。
方法：我们进行了回顾性研究，非干预性队列研究基于来自德国法定健康保险的匿名索赔数据,涵盖2016年至2021年.我们将开始生物治疗的银屑病成年患者纳入药物特异性队列。经过365天的随访，我们评估了不同生物制剂停止治疗的频率和时间.使用多变量Cox比例风险模型比较了停药率的差异。
结果：总共2565例开始使用苏金单抗治疗的银屑病患者（n=612），阿达木单抗（n=454），guselkumab（n=354），ixekizumab（n=259），ustekinumab（n=241），tildrakizumab（n=205），Brodalumab（n=166），利安珠单抗（n=145），依那西普（n=91），赛托珠单抗（n=29），包括英夫利昔单抗（n=9）。共有1290例患者(50.29%)在随访期间停止治疗,范围从30.34%（利沙单抗）到69.23%（依那西普）。直至停止治疗的中位时间范围为102天(依那西普)至208天(利沙单抗)。一旦生物治疗停止，45.05％的患者使用相同的药物重新开始治疗，23.10%的患者改用另一种生物制剂，31.86%未接受进一步的生物制剂。与利沙珠单抗治疗的患者相比，除ustekinumab外,接受其他生物制剂治疗的患者停药率显著较高(p<0.05)(p=0.12).
结论：进一步的研究应探索导致治疗中断的原因，以支持中重度银屑病患者的治疗选择。
方法：我们进行了回顾性研究，非干预性队列研究基于来自德国法定健康保险的匿名索赔数据,涵盖2016年至2021年.我们将开始生物治疗的银屑病成年患者纳入药物特异性队列。经过365天的随访，我们评估了不同生物制剂停止治疗的频率和时间.使用多变量Cox比例风险模型比较了停药率的差异。
结果：总共2565例开始使用苏金单抗治疗的银屑病患者（n=612），阿达木单抗（n=454），guselkumab（n=354），ixekizumab（n=259），ustekinumab（n=241），tildrakizumab（n=205），Brodalumab（n=166），利安珠单抗（n=145），依那西普（n=91），赛托珠单抗（n=29），包括英夫利昔单抗（n=9）。共有1290例患者(50.29%)在随访期间停止治疗,范围从30.34%（利沙单抗）到69.23%（依那西普）。直至停止治疗的中位时间范围为102天(依那西普)至208天(利沙单抗)。一旦生物治疗停止，45.05％的患者使用相同的药物重新开始治疗，23.10%的患者改用另一种生物制剂，31.86%未接受进一步的生物制剂。与利沙珠单抗治疗的患者相比，除ustekinumab外,接受其他生物制剂治疗的患者停药率显著较高(p<0.05)(p=0.12).
结论：进一步的研究应探索导致治疗中断的原因，以支持中重度银屑病患者的治疗选择。
