期刊
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
卷 68, 期 1, 页码 64-72出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2012.06.035
关键词
biologics; cost; effectiveness; inconvenience; phototherapy; psoriasis; safety; systemic treatments; treatment discontinuation
类别
资金
- National Institutes of Health [T32-AR07465, 1KM1CA156723]
- National Institute of Arthritis and Musculoskeletal and Skin Diseases [RC1-AR058204]
- Abbott
- Amgen
- Centocor
- Janssen
- Stiefel Laboratories
- Wyeth
- Pfizer
- Eli Lilly
- Galderma
- PhotoMedex
- Genentech
- Novartis
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.)
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