title: Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting.
abstract: OBJECTIVE
  To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis.
  
  
  METHODS
  A cross-sectional design was used.
  
  
  METHODS
  Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study.
  
  
  METHODS
  A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy.
  
  
  METHODS
  The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index.
  
  
  RESULTS
  The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency.
  
  
  CONCLUSIONS
  The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA. joel.gelfand@uphs.upenn.edu
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.forename: Joy
authors.initials: J
authors.lastname: Wan
authors.forename: Kristina
authors.initials: K
authors.lastname: Callis Duffin
authors.forename: Gerald G
authors.initials: GG
authors.lastname: Krueger
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kalb
authors.forename: Jamie D
authors.initials: JD
authors.lastname: Weisman
authors.forename: Brian R
authors.initials: BR
authors.lastname: Sperber
authors.forename: Michael B
authors.initials: MB
authors.lastname: Stierstorfer
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Brod
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schleicher
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Bebo
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Shin
authors.forename: Jane M
authors.initials: JM
authors.lastname: Steinemann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Goldfarb
authors.forename: Howa
authors.initials: H
authors.lastname: Yeung
authors.forename: Abby S
authors.initials: AS
authors.lastname: Van Voorhees
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D003430:Cross-Sectional Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000628:therapy*; D011788:Quality of Life; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014467:Ultraviolet Therapy; D014481:United States; D000069549:Ustekinumab
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate