title: Retrospective analysis of the effectiveness and costs of traditional treatments for moderate-to-severe psoriasis: A single-center, Italian study.
abstract: BACKGROUND
  Current guidelines recommend the use of systemic therapy and phototherapy for the treatment of moderate-to-severe plaque psoriasis.
  
  
  OBJECTIVE
  To evaluate the effectiveness, impact on health status perception, and costs of traditional systemic therapies and phototherapy in real-life patients with moderate-to-severe psoriasis.
  
  
  METHODS
  Retrospective analysis of data from 100 psoriatic patients referring to a dermatology clinic in Italy and treated with traditional therapies.
  
  
  RESULTS
  Patients were predominantly treated with cyclosporine (72%). Cyclosporine was associated with fewer treatment discontinuations due to lack of efficacy (37%) compared with methotrexate (65%), acitretin (67%) and phototherapy (50%). Rates of treatment discontinuation due to adverse events were: cyclosporine (24%), methotrexate (9%), acitretin (25%) and phototherapy (0%). Improvements in PASI scores were comparable between treatments. The need for topical therapy was reduced with cyclosporine versus other therapies (35% vs 71%, p = 0.0009); respectively, 33% of patients treated with cyclosporine versus 14% of patients receiving other therapies perceived an improvement in their health status (p = 0.0018). Mean total per-patient direct costs of the first treatment cycle were higher with cyclosporine than with other therapies (€1812.85 vs €648.90, p < 0.0001).
  
  
  CONCLUSIONS
  Cyclosporine was effective even if more expensive than other traditional therapies. Nevertheless patients' perception of improvement was quite low.
authors.affiliation: a Dermatology and Venereology Private Practice , Taranto , Italy .
authors.forename: Antonio
authors.initials: A
authors.lastname: Carpentieri
authors.affiliation: b Clinica Dermatologica , Policlinico Di Bari , Bari , Italy .
authors.forename: Lucia
authors.initials: L
authors.lastname: Pacello
authors.affiliation: b Clinica Dermatologica , Policlinico Di Bari , Bari , Italy .
authors.forename: Immacolata Maria
authors.initials: IM
authors.lastname: De Marco
authors.affiliation: c Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy , and.
authors.forename: Anna
authors.initials: A
authors.lastname: Loiacono
authors.affiliation: d National AIDS Center, Istituto Superiore Di Sanità , Rome , Italy.
authors.forename: Orietta
authors.initials: O
authors.lastname: Picconi
authors.affiliation: b Clinica Dermatologica , Policlinico Di Bari , Bari , Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Loconsole
mesh_terms: D017255:Acitretin / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008727:Methotrexate / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D010789:Phototherapy / Q000191:economics* / Q000379:methods; D011565:Psoriasis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine; D017255:Acitretin; D008727:Methotrexate
keywords: Psoriasis vulgaris; acitretin; cyclosporine; methotrexate; phototherapy; systemic therapy