title: Determinants of drug survival for etanercept in a long-term daily practice cohort of patients with psoriasis.
abstract: BACKGROUND
  Long-term data of etanercept drug survival in patients with psoriasis in daily practice are scarce.
  
  
  OBJECTIVE
  The primary objective was to describe drug survival for etanercept in a long-term daily practice cohort of patients with psoriasis. The secondary objective was to identify determinants of drug survival for etanercept in general and separately for discontinuation due to adverse events or ineffectiveness of therapy.
  
  
  METHODS
  Data were extracted from a prospective daily practice cohort of patients treated with biologics for psoriasis. Drug survival was analysed by Kaplan-Meier survival curves and split for two reasons for discontinuation: adverse events and ineffectiveness. Determinants of drug survival were analysed using univariate Cox regression analysis and multivariate Cox regression analysis with backward selection.
  
  
  RESULTS
  We included 193 patients (512 patient-years treated) with a maximum treatment duration of 7·5 years. The overall drug survival rates were 77%, 41% and 30% after 1, 4 and 7·5 years, respectively. The mean survival duration was 3·8 years (95% confidence interval 3·4-4·3). Reasons for discontinuation were ineffectiveness (33·7%), adverse events (11·9%), both ineffectiveness and adverse events (4·7%) or other reasons (e.g. pregnancy planned) (5·7%). Determinants related to longer general drug survival were male sex [hazard ratio (HR) 0·55], prior anti-tumour necrosis factor (TNF)-α use (HR 0·57) and lower etanercept dose (HR 0·65). Younger age (HR 0·83), lower body mass index (HR 0·63) and lower etanercept dose (HR 0·71) were related to a decreased risk of discontinuation due to side-effects. A lower mean weekly dose of etanercept (HR 0·63) was related to a decreased risk of discontinuation due to ineffectiveness of therapy.
  
  
  CONCLUSIONS
  We present the longest analysis of drug survival for etanercept in psoriasis to date. Determinants of longer overall etanercept drug survival were male sex, prior anti-TNF therapy and lower etanercept dose. The determinants of longer drug survival depended on the reason for discontinuation of etanercept.
authors.affiliation: Department of Dermatology, Radboud University Nijmegen Medical Centre, René Descartesdreef 1, 6525 GL, Nijmegen, the Netherlands.
authors.forename: J M P A
authors.initials: JM
authors.lastname: van den Reek
authors.forename: P P M
authors.initials: PP
authors.lastname: van Lümig
authors.forename: R J B
authors.initials: RJ
authors.lastname: Driessen
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.forename: M M B
authors.initials: MM
authors.lastname: Seyger
authors.forename: W
authors.initials: W
authors.lastname: Kievit
authors.forename: E M G J
authors.initials: EM
authors.lastname: de Jong
mesh_terms: D003879:Dermatologic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept