Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis

详细信息    查看全文

• 作者：Howa Yeung ; BS^a ; Joy Wan ; BA^a ; Abby S. Van Voorhees ; MD^a ; Kristina Callis Duffin ; MD^c ; Gerald G. Krueger ; MD^c ; Robert E. Kalb ; MD^d ; Jamie D. Weisman ; MD^e ; Brian R. Sperber ; MD ; PhD^f ; Bruce A. Brod ; MD^a ; Stephen M. Schleicher ; MD^g ; Bruce F. Bebo Jr. Jr. ; PhD^h ; Daniel B. Shin ; MS^a ; ^b ; Andrea B. Troxel ; ScD^b ; Joel M. Gelfand ; MD ; MSCE^a ; ^b ; ^{joel.gelfand@uphs.upenn.edu}
• 关键词：biologics ; cost ; effectiveness ; inconvenience ; phototherapy ; psoriasis ; safety ; systemic treatments ; treatment discontinuation
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：68
• 期：1
• 页码：64-72
• 全文大小：143 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Background

Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood.

Objectives

We sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice.

Methods

A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments.

Results

A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months (P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio [OR] 5.19; 95 % confidence interval [CI] 3.23-8.33) and adalimumab (OR 2.10; 95 % CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95 % CI 0.23-0.49), adalimumab (OR 0.48; 95 % CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95 % CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95 % CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95 % CI 3.14-15.72).

Limitations

The study is limited by its reliance on patient recall.

Conclusions

Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.