Adalimumab for the treatment of psoriasis in real life: a retrospective cohort of 119 patients at a single Spanish centre

BackgroundPatients with moderate-to-severe psoriasis treated with adalimumab in daily clinical practice are different from those in clinical trials, and outcomes may differ in different geographical settings. ObjectivesTo analyse the efficacy, retention of treatment and adverse events in a cohort of such patients at a referral centre in Barcelona, Spain. MethodsData from a cohort of 119 consecutive patients treated between January 2008 and March 2013 were retrospectively collected. Drug survival was analysed by the Kaplan-Meier method with log-rank test and Cox regression. ResultsThe mean duration of treatment was 25months (median 22, range 2-60). The 75% improvement in Psoriasis Area and Severity Index (PASI 75) response rates at 16weeks, 6months and 1year of treatment were 64%, 58% and 53%, respectively (intention-to-treat analysis). The corresponding PASI 90 values were 49%, 52% and 50%. Biologic-naive patients (41%) had significantly higher PASI 75 and PASI 90 response rates at 6months and 1year. On multivariate analysis, only PASI 90 response at 6months was significantly associated with treatment retention (P=00009), with a hazard ratio of 73 (95% confidence interval 23-236). Forty-eight adverse events (AEs) occurred in 29 patients, and were serious in eight (0032 events per patient-year). Paradoxical flares of psoriasis or arthritis were seen in five patients. Infections accounted for seven serious AEs, and were the reason for discontinuation in two patients. ConclusionsPASI 90 response at 6months was the only independent variable predicting drug survival on multivariate analysis. Infections, including de novo infection by Mycobacterium tuberculosis, accounted for seven serious AEs.