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

被引:103
|
作者
Yeung, Howa [1 ]
Wan, Joy [1 ]
Van Voorhees, Abby S. [1 ]
Duffin, Kristina Callis [3 ]
Krueger, Gerald G. [3 ]
Kalb, Robert E. [4 ]
Weisman, Jamie D. [5 ]
Sperber, Brian R. [6 ]
Brod, Bruce A. [1 ]
Schleicher, Stephen M. [7 ]
Bebo, Bruce F., Jr. [8 ]
Shin, Daniel B. [1 ,2 ]
Troxel, Andrea B. [2 ]
Gelfand, Joel M. [1 ,2 ]
机构
[1] Univ Penn, Perelman Sch Med, Dept Dermatol, Philadelphia, PA 19104 USA
[2] Univ Penn, Ctr Clin Epidemiol & Biostat, Dept Epidemiol & Biostat, Philadelphia, PA 19104 USA
[3] Univ Utah, Sch Med, Dept Dermatol, Salt Lake City, UT USA
[4] SUNY Buffalo, Sch Med, Dept Dermatol, Buffalo, NY 14260 USA
[5] Peachtree Dermatol Associates, Atlanta, GA USA
[6] Colorado Springs Dermatol Clin, Colorado Springs, CO USA
[7] DermDox Ctr Dermatol, Hazleton, PA USA
[8] Natl Psoriasis Fdn, Portland, OR USA
基金
美国国家卫生研究院;
关键词
biologics; cost; effectiveness; inconvenience; phototherapy; psoriasis; safety; systemic treatments; treatment discontinuation; FOUNDATION CLINICAL CONSENSUS; POPULATION-BASED COHORT; SEVERE PLAQUE PSORIASIS; DRUG SURVIVAL RATES; SYSTEMIC TREATMENTS; MYOCARDIAL-INFARCTION; DISEASE SEVERITY; THERAPY; RISK; ADALIMUMAB;
D O I
10.1016/j.jaad.2012.06.035
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
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. (J Am Acad Dermatol 2013;68:64-72.)
引用
收藏
页码:64 / 72
页数:9
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