E Sbidian1,2,3, C Giboin4, H Bachelez5, C Paul6, M Beylot-Barry7, A Dupuy8, M Viguier9, J-P Lacour10, J-L Schmutz11, P Bravard12, E Mahé13, N Beneton14, L Misery15, E Delaporte16, P Modiano17, S Barbarot18, E Regnier19, D Jullien20, M-A Richard21, P Joly22, F Tubach4,23,24, O Chosidow1,2,3. 1. Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, UPEC, Créteil, France. 2. INSERM, Centre d'Investigation Clinique 1430, Créteil, France. 3. EA 7379 EpidermE, Université Paris-Est Créteil (UPEC), Créteil, France. 4. Département Biostatistique, Santé Publique et Information Médicale, Centre de Pharmaco-épidémiologie, CIC 1421, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France. 5. Service de Dermatologie, Institut Imagine, AP-HP Hôpital Saint-Louis, INSERM UMR 1163, SorbonneParis Cité Université Paris Diderot, Paris, France. 6. Département de Dermatologie, Hôpitaux Universitaires de Toulouse, UMR INSERM 1056, Université Paul Sabatier, Toulouse, France. 7. Département de Dermatologie, INSERM U1053, Hôpital Saint-André, Université de Bordeaux, Bordeaux, France. 8. Département de Dermatologie, INSERM CIC 1414, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France. 9. Département de Dermatologie, Hôpitaux Universitaires Robert Debré, Reims, France. 10. Département de Dermatologie, Centre de Référence Maladies Rares, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France. 11. Département de Dermatologie et Allergologie, Hôpitaux de Brabois, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France. 12. Département de Dermatologie, Groupe Hospitalier du Havre, Le Havre, France. 13. Département de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France. 14. Département de Dermatologie, Centre Hospitalier du Mans, Le Mans, France. 15. Département de Dermatologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France. 16. Département de Dermatologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 17. Département de Dermatologie, Groupement des Hôpitaux de l'Institut Catholique de Lille, Hôpital Saint-Vincent-de-Paul, Lille, France. 18. Département de Dermatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France. 19. Département de Dermatologie, AP-HP, Hôpitaux Universitaires Cochin, Université Paris Descartes Paris V, Paris, France. 20. Département de Dermatologie, HCL, Centre Hospitalier Universitaire, Hôpital Edouard Herriot, Lyon, France. 21. Département de Dermatologie, Centre Hospitalier Universitaire, Hôpital La Timone, Marseille, France. 22. Department of Dermatology, Rouen University Hospital, INSERM U 1234, Normandie University, Rouen, France. 23. Université Pierre et Marie Curie, Sorbonne Universités, Paris, France. 24. UMR 1123, CIC 1421, ECEVE, INSERM, Paris, France.
Abstract
BACKGROUND: Decision-making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis. METHODS: Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified as follows: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion. RESULTS: The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (±SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept (n = 247, 29.8%), ustekinumab (n = 194, 23.4%) and infliximab (n = 34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept (aOR, 0.42; 95% CI, 0.16-1.07) and ustekinumab (aOR, 0.15; 95% CI, 0.04-0.52). Patients were significantly more likely to receive ustekinumab (aOR, 2.39; 95% CI, 1.04-5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favour of etanercept prescription in patients with cardiovascular comorbidities, metabolic syndrome and in patients with a history of cancer. CONCLUSION: We identified patient- and disease-related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis.
BACKGROUND: Decision-making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis. METHODS: Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified as follows: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion. RESULTS: The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (±SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept (n = 247, 29.8%), ustekinumab (n = 194, 23.4%) and infliximab (n = 34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept (aOR, 0.42; 95% CI, 0.16-1.07) and ustekinumab (aOR, 0.15; 95% CI, 0.04-0.52). Patients were significantly more likely to receive ustekinumab (aOR, 2.39; 95% CI, 1.04-5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favour of etanercept prescription in patients with cardiovascular comorbidities, metabolic syndrome and in patients with a history of cancer. CONCLUSION: We identified patient- and disease-related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis.
Authors: Sandro C Furiati; Jonatas S Catarino; Marcos V Silva; Rafaela F Silva; Rayane B Estevam; Reginaldo B Teodoro; Sanivia L Pereira; Meire Ataide; Virmondes Rodrigues; Denise B R Rodrigues Journal: Sci Rep Date: 2019-05-17 Impact factor: 4.379