title: A comparison of psoriasis drug failure rates and reasons for discontinuation in biologics vs conventional systemic therapies.
abstract: BACKGROUND
  Although biologic therapies have been shown to be more effective than traditional systemic therapies in clinical trials for the treatment of psoriasis, the drug survival time and reasons for discontinuation of biologics in clinical practice have not been compared with those of conventional systemic therapies.
  
  
  METHODS
  Retrospective, cross-sectional.
  
  
  METHODS
  All patient visits coded for psoriasis (ICD-0 696.1) in the clinical practice of 2 dermatologists from January 1 2008 through January 4 2012 were included in this retrospective data analysis. The practice is a comprehensive psoriasis care center in the northeastern United States serving a metropolitan population of over 4 million people. Patients were divided by treatment type: biologic or traditional systemic. Treatment failure was defined as discontinuation of treatment course for any reason. Patient time to failure for each therapy was calculated, as were previous treatments and reasons for treatment discontinuation.
  
  
  RESULTS
  One hundred and fifty-nine patients who underwent 284 courses of treatment were studied. Forty-eight percent of biologics failed in an average of 242 days, compared with 75% of traditional systemics (P<.0001), which failed in an average of 143 days (P<.0001). Infliximab had the longest survival time (292 days), and ustekinumab had the smallest failure rate (39%). Reasons for discontinuation differed significantly between biologics and systemics, with biologics being discontinued more often due to loss of efficacy (P=.0014), and systemics failing significantly more frequently due to adverse events (P<.001). Adverse events were observed most frequently with methotrexate and infliximab, while golimumab had the highest rates of both loss and lack of efficacy.
  
  
  CONCLUSIONS
  Biologics had longer survival times and lower failure rates than traditional systemics in the treatment of psoriasis. Biologics were more likely to be discontinued due to loss of efficacy, and systemics were more likely to fail due to adverse events.
authors.forename: Adriane A
authors.initials: AA
authors.lastname: Levin
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
authors.forename: Shiu-chung
authors.initials: SC
authors.lastname: Au
mesh_terms: D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D007155:Immunologic Factors