Treatment patterns and therapy effectiveness in psoriasis patients initiating biologic therapy in England

Objective: To describe biologic treatment patterns and effectiveness among patients with psoriasis who initiated biologic therapy. Methods: A chart review was conducted for 169 patients with psoriasis initiating biologic treatment between 1 July 2005 and 30 June 2009 from six dermatology clinics. Severity was measured by the Psoriasis Area and Severity Index (PASI) at baseline and time of treatment change. Biologic treatment patterns in the 12 months following initiation (discontinuation, switching, dose increase, and persistence) were collected. Results: Mean (SD) PASI score at initiation was 18.4 (7.8). Eighteen percent of patients discontinued biologic use, 12% switched, and 7% increased biologic dose within the first 12 months. Patients persistent on initial biologic therapy (64%) achieved a mean PASI score of 3.8 at 12 months; 69% achieved PASI >= 75. For patients who discontinued due to lack of effectiveness, mean PASI score was 22.6; no patient reached PASI >= 75. Among patients who switched, mean PASI was 15.7 (0% PASI >= 75) at the time of switch. In those who increased their dose, mean PASI score was 9.1 (43% reached PASI >= 75) at the time of dose increase. Conclusions: A large proportion (36%) of patients changed or discontinued biologic therapy within the first year. These patients experienced limited PASI response, if any, suggesting an unmet need for this population.