Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

BackgroundTreatment modifications, including dose escalations, dose reductions, switches, discontinuations and restarts of biologics may be necessary in the management of psoriasis but the patterns of usage are incompletely defined. ObjectivesTo examine the treatment utilization patterns of adalimumab, etanercept and ustekinumab among biologic-naive and non-naive patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR). MethodsThe study cohort included adults with chronic plaque psoriasis who were followed up for 12 months. Treatment modifications were assessed during the first year of therapy. The time-trend method, comparing the cumulative dose (CD) patients received with the recommended cumulative dose (RCD), was used to assess dosing patterns. Concomitant use of other systemic treatments was also examined. ResultsIn total, 2980 patients (adalimumab: 1675; etanercept: 996; ustekinumab: 309) were included; 792% were biologic-naive. Over 12 months, 774% of patients continued the biologic, 26% restarted therapy after a break of 90 days, 25% discontinued, and 175% switched biologic therapy. Most patients (857%) received the RCD of the biologic, although 81% were exposed to a higher CD. In total, 749 (251%) patients used conventional systemic therapies concomitantly with a biologic at some stage; methotrexate was used most commonly (458; 612%). Of those using combination therapy, 454 (606%) continued the use of the conventional systemic therapy for > 120 days after the start of the biologic. ConclusionsMore than one-third of patients experienced treatment modifications within the first year of initiating a biologic. Conventional systemic therapies, particularly methotrexate, were commonly used concurrently, which should be considered when evaluating treatment response and adverse events to biologics in real-world observational studies.