Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting.
| Title: | Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting. |
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| Authors: | Takeshita J; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: Junko.Takeshita@uphs.upenn.edu.; Wang S; Thomas Jefferson University, Philadelphia, Pennsylvania.; Shin DB; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Callis Duffin K; Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah.; Krueger GG; Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah.; Kalb RE; Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.; Weisman JD; Peachtree Dermatology Associates, Atlanta, Georgia.; Sperber BR; Colorado Springs Dermatology Clinic, Colorado Springs, Colorado.; Stierstorfer MB; East Penn Dermatology, North Wales, Pennsylvania.; Brod BA; Dermatology Associates of Lancaster, Lancaster, Pennsylvania.; Schleicher SM; DermDox Centers for Dermatology, Hazleton, Pennsylvania.; Robertson AD; National Psoriasis Foundation, Portland, Oregon.; Linn KA; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Shinohara RT; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Troxel AB; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Van Voorhees AS; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Gelfand JM; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. |
| Source: | Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2014 Dec; Vol. 71 (6), pp. 1167-75. Date of Electronic Publication: 2014 Sep 24. |
| Publication Type: | Comparative Study; Journal Article; Multicenter Study; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Mosby Country of Publication: United States NLM ID: 7907132 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6787 (Electronic) Linking ISSN: 01909622 NLM ISO Abbreviation: J Am Acad Dermatol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: St. Louis, Mo., Mosby |
| MeSH Terms: | Severity of Illness Index*; Methotrexate/*therapeutic use ; Psoriasis/*drug therapy; Acitretin/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Cyclosporine/therapeutic use ; Dermatologic Agents/therapeutic use ; Immunoglobulin G/therapeutic use ; Keratolytic Agents/therapeutic use ; Receptors, Tumor Necrosis Factor/therapeutic use ; Adalimumab ; Adult ; Aged ; Cross-Sectional Studies ; Drug Therapy, Combination ; Etanercept ; Female ; Humans ; Infliximab ; Male ; Middle Aged ; Young Adult |
| Abstract: | Background: The effectiveness of psoriasis therapies in real-world settings remains relatively unknown.; Objective: We sought to compare the effectiveness of less commonly used systemic therapies and commonly used combination therapies for psoriasis.; Methods: This was a multicenter cross-sectional study of 203 patients with plaque psoriasis receiving less common systemic monotherapy (acitretin, cyclosporine, or infliximab) or common combination therapies (adalimumab, etanercept, or infliximab and methotrexate) compared with 168 patients receiving methotrexate evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network.; Results: In adjusted analyses, patients on acitretin (relative response rate 2.01; 95% confidence interval [CI] 1.18-3.41), infliximab (relative response rate 1.93; 95% CI 1.26-2.98), adalimumab and methotrexate (relative response rate 3.04; 95% CI 2.12-4.36), etanercept and methotrexate (relative response rate 2.22; 95% CI 1.25-3.94), and infliximab and methotrexate (relative response rate 1.72; 95% CI 1.10-2.70) were more likely to have clear or almost clear skin compared with patients on methotrexate. There were no differences among treatments when response rate was defined by health-related quality of life.; Limitations: Single time point assessment may result in overestimation of effectiveness.; Conclusions: The efficacy of therapies in clinical trials may overestimate their effectiveness as used in clinical practice. Although physician-reported relative response rates were different among therapies, absolute differences were small and did not correspond to differences in patient-reported outcomes.; (Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.) |
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| Grant Information: | K24 AR064310 United States AR NIAMS NIH HHS; RC1 AR058204 United States AR NIAMS NIH HHS; T32-AR007465 United States AR NIAMS NIH HHS; T32 GM075766 United States GM NIGMS NIH HHS; RC1-AR058204 United States AR NIAMS NIH HHS; T32 AR007465 United States AR NIAMS NIH HHS; K24-AR064310 United States AR NIAMS NIH HHS |
| Contributed Indexing: | Keywords: Dermatology Life Quality Index; Physician Global Assessment; biologics; combination therapy; comparative effectiveness; psoriasis; quality of life; systemic treatments |
| Substance Nomenclature: | 0 (Anti-Inflammatory Agents); 0 (Antibodies, Monoclonal); 0 (Antibodies, Monoclonal, Humanized); 0 (Dermatologic Agents); 0 (Immunoglobulin G); 0 (Keratolytic Agents); 0 (Receptors, Tumor Necrosis Factor); 83HN0GTJ6D (Cyclosporine); B72HH48FLU (Infliximab); FYS6T7F842 (Adalimumab); LCH760E9T7 (Acitretin); OP401G7OJC (Etanercept); YL5FZ2Y5U1 (Methotrexate) |
| Entry Date(s): | Date Created: 20140928 Date Completed: 20150204 Latest Revision: 20211021 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC4271825 |
| DOI: | 10.1016/j.jaad.2014.08.003 |
| PMID: | 25260564 |
| Database: | MEDLINE |
Comparative Study; Journal Article; Multicenter Study; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't