Biological treatment of psoriasis shows a good efficacy in clinical trials. Since most analyses have focused on short-term outcomes of single biological agents, little has been known about long-term outcomes in clinical practice, where switching between biological agents is common. A Swedish study that followed 583 individuals for up to 10 years shows a satisfactory long-term effectiveness of biologic treatments. The findings were recently published in the British Journal of Dermatology.
"We employed a real-life patient perspective in this study," says Marcus Schmitt-Egenolf, professor at the Department of Public Health and Clinical Medicine at Umeå University and senior author of the study.
"Most studies in this area were initiated by the industry and conducted in controlled settings that are ultimately beneficial for their product. Consequently, those studies cannot really predict how a product will perform under real-life circumstances, with real-life patients."
The current study was based on data from repeated consultations of patients included in the Swedish psoriasis register and conducted by researchers at Umeå University and the Swedish Institute for Health Economics (IHE) in Lund.
Psoriasis is a common autoimmune skin disease affecting about three percent of the western population. Moderate-to-severe psoriasis is associated with a dose-dependent risk for cardiovascular and metabolic morbidity. In the beginning of the century, the introduction of a new class of drugs for psoriasis, biologics, transformed the treatment of moderate-to-severe psoriasis by providing better skin clearance rates, low toxicity, and improved quality-of-life. This study, following real-life patients for up to ten years, shows now that these good effects do not diminish over time.
In the study, researchers analysed three different measurements: the clinical measurement Psoriasis Area Severity Index (PASI), the DLQI which measures the impact of skin diseases on the quality of life, and the EQ-5D measurement, which analyses the general health-related quality of life.
"In all three of these measures of treatment outcome we found significant differences between before- and after the switch to biological treatment, both at 3-5 months after the switch and also sustained over the entire observed timespan," says Marcus Schmitt-Egenolf.
"Our results suggest that both the clinical effectiveness and the impressive effects on the quality of life under biological treatment as used in clinical practice are sustained over time. These results may support clinicians in initiating and continuing biological treatment for patients with poor outcomes under conventional treatment. This is an important finding from an international perspective, as data on real-life long-time outcomes of biological treatment is rare but crucial for treatment guidelines," concludes Marcus Schmitt-Egenolf.
Article: Sustained PASI, DLQI and EQ-5D response of biological treatment in psoriasis: 10 years of real-world data in the Swedish National Psoriasis Register, F Hjalte, K Steen Carlsson and M. Schmitt-Egenolf, The British Journal of Dermatology, doi: 10.1111/bjd.15757, published online 23 June 2017.