title: 'Happy' drug survival of adalimumab, etanercept and ustekinumab in psoriasis in daily practice care: results from the BioCAPTURE network.
abstract: BACKGROUND
  Drug survival is a marker for treatment success. To date, no analyses relating dermatological quality-of-life measures to drug survival have been published.
  
  
  OBJECTIVE
  (i) To describe 1-year drug survival for adalimumab, etanercept and ustekinumab in a daily practice psoriasis cohort, and (ii) to introduce the concept of 'happy' drug survival, defined as Dermatology Life Quality Index (DLQI) ≤ 5 combined with being 'on drug' at a specific time point.
  
  
  METHODS
  Data were extracted from a prospective registry. Drug survival was analysed using Kaplan-Meier estimates. 'Happy' drug survival was calculated, with data split into 'happy' (DLQI ≤ 5) vs. 'unhappy' (DLQI > 5) at baseline and months 3, 6, 9 and 12.
  
  
  RESULTS
  249 treatment episodes were included (101 adalimumab, 82 etanercept, 66 ustekinumab). The 1-year drug survival rates for ustekinumab, adalimumab and etanercept were 85%, 74% and 68%, respectively. Ustekinumab showed a better confounder-corrected drug survival vs. etanercept [hazard ratio (HR) 3·8, P = 0·02] and a trend towards better survival vs. adalimumab (HR 2·3, P = 0·1). At baseline, the majority (n = 115, 73%) was considered 'unhappy' and a minority 'happy' (n = 42, 27%) (ratio 'happy':'unhappy' was 1 : 2.7). The percentage of treatment episodes with 'happy' on-drug patients increased to 79% after 1 year.
  
  
  CONCLUSIONS
  Ustekinumab showed a better overall drug survival than etanercept, and a trend towards a better overall drug survival than adalimumab. After 1 year, patients reported to be 'happy' in 79% of episodes and 'unhappy' in 21%. We introduced the new concept of 'happy' drug survival because the proportion of on-drug patients with good quality of life is an important indicator for treatment success.
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: J M P A
authors.initials: JM
authors.lastname: van den Reek
authors.forename: J
authors.initials: J
authors.lastname: Zweegers
authors.forename: W
authors.initials: W
authors.lastname: Kievit
authors.forename: M E
authors.initials: ME
authors.lastname: Otero
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 M
authors.initials: PM
authors.lastname: Ossenkoppele
authors.forename: M D
authors.initials: MD
authors.lastname: Njoo
authors.forename: J M
authors.initials: JM
authors.lastname: Mommers
authors.forename: M I A
authors.initials: MI
authors.lastname: Koetsier
authors.forename: W P
authors.initials: WP
authors.lastname: Arnold
authors.forename: B A M
authors.initials: BA
authors.lastname: Sybrandy-Fleuren
authors.forename: A L A
authors.initials: AL
authors.lastname: Kuijpers
authors.forename: M P M
authors.initials: MP
authors.lastname: Andriessen
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: E M G J
authors.initials: EM
authors.lastname: de Jong
mesh_terms: D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D057915:Drug Substitution; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D011788:Quality of Life; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome; D000069549:Ustekinumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept