title: Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting.
abstract: BACKGROUND
  The effectiveness of psoriasis therapies in real-world settings remains relatively unknown.
  
  
  OBJECTIVE
  We sought to compare the effectiveness of less commonly used systemic therapies and commonly used combination therapies for psoriasis.
  
  
  METHODS
  This was a multicenter cross-sectional study of 203 patients with plaque psoriasis receiving less common systemic monotherapy (acitretin, cyclosporine, or infliximab) or common combination therapies (adalimumab, etanercept, or infliximab and methotrexate) compared with 168 patients receiving methotrexate evaluated at 1 of 10 US outpatient dermatology sites participating in the Dermatology Clinical Effectiveness Research Network.
  
  
  RESULTS
  In adjusted analyses, patients on acitretin (relative response rate 2.01; 95% confidence interval [CI] 1.18-3.41), infliximab (relative response rate 1.93; 95% CI 1.26-2.98), adalimumab and methotrexate (relative response rate 3.04; 95% CI 2.12-4.36), etanercept and methotrexate (relative response rate 2.22; 95% CI 1.25-3.94), and infliximab and methotrexate (relative response rate 1.72; 95% CI 1.10-2.70) were more likely to have clear or almost clear skin compared with patients on methotrexate. There were no differences among treatments when response rate was defined by health-related quality of life.
  
  
  CONCLUSIONS
  Single time point assessment may result in overestimation of effectiveness.
  
  
  CONCLUSIONS
  The efficacy of therapies in clinical trials may overestimate their effectiveness as used in clinical practice. Although physician-reported relative response rates were different among therapies, absolute differences were small and did not correspond to differences in patient-reported outcomes.
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: Junko.Takeshita@uphs.upenn.edu.
authors.forename: Junko
authors.initials: J
authors.lastname: Takeshita
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Shuwei
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Shin
authors.affiliation: Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Kristina
authors.initials: K
authors.lastname: Callis Duffin
authors.affiliation: Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Gerald G
authors.initials: GG
authors.lastname: Krueger
authors.affiliation: Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kalb
authors.affiliation: Peachtree Dermatology Associates, Atlanta, Georgia.
authors.forename: Jamie D
authors.initials: JD
authors.lastname: Weisman
authors.affiliation: Colorado Springs Dermatology Clinic, Colorado Springs, Colorado.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Sperber
authors.affiliation: East Penn Dermatology, North Wales, Pennsylvania.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Stierstorfer
authors.affiliation: Dermatology Associates of Lancaster, Lancaster, Pennsylvania.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Brod
authors.affiliation: DermDox Centers for Dermatology, Hazleton, Pennsylvania.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schleicher
authors.affiliation: National Psoriasis Foundation, Portland, Oregon.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Robertson
authors.affiliation: Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Linn
authors.affiliation: Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.affiliation: Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Van Voorhees
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D017255:Acitretin / Q000627:therapeutic use; D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D007641:Keratolytic Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D007641:Keratolytic Agents; D018124:Receptors, Tumor Necrosis Factor; D016572:Cyclosporine; D000069285:Infliximab; D000068879:Adalimumab; D017255:Acitretin; D000068800:Etanercept; D008727:Methotrexate
keywords: Dermatology Life Quality Index; Physician Global Assessment; biologics; combination therapy; comparative effectiveness; psoriasis; quality of life; systemic treatments