title: Comparative effectiveness of biologic agents for the treatment of psoriasis in a real-world setting: Results from a large, prospective, observational study (Psoriasis Longitudinal Assessment and Registry [PSOLAR]).
abstract: BACKGROUND
  Comparing effectiveness of biologics in real-world settings will help inform treatment decisions.
  
  
  OBJECTIVE
  We sought to compare therapeutic responses among patients initiating infliximab, adalimumab, or etanercept versus ustekinumab during the Psoriasis Longitudinal Assessment and Registry (PSOLAR).
  
  
  METHODS
  Proportions of patients achieving a Physician Global Assessment score of clear (0)/minimal (1) and mean decrease in percentage of body surface area with psoriasis were evaluated at 6 and 12 months. Adjusted logistic regression (Physician Global Assessment score 0/1) and analysis of covariance (percentage of body surface area with psoriasis) were performed to determine treatment factors associated with effectiveness.
  
  
  RESULTS
  Of 2541 new users on registry, 2076 had efficacy data: ustekinumab (n = 1041), infliximab (n = 116), adalimumab (n = 662), and etanercept (n = 257). Patients receiving tumor necrosis factor-alpha(-α) inhibitors were significantly less likely to achieve Physician Global Assessment score 0/1 versus ustekinumab (infliximab [odds ratio {OR} 0.396, P < .0001], adalimumab [OR 0.686, P = .0012], etanercept [OR 0.554, P = .0003] at 6 months and infliximab [OR 0.449, P = .0040] at 12 months). Mean decrease in percentage of body surface area with psoriasis was significantly greater for ustekinumab versus adalimumab (point estimate 1.833, P = .0020) and etanercept (point estimate 3.419, P < .0001) at 6 months and versus infliximab (point estimate 3.945, P = .0005) and etanercept (point estimate 2.778, P = .0007) at 12 months.
  
  
  CONCLUSIONS
  Treatment selection bias and limited data for doing adjustments are limitations.
  
  
  CONCLUSIONS
  In PSOLAR, effectiveness of ustekinumab was significantly better versus all 3 tumor necrosis factor-α inhibitors studied for the majority of comparisons at 6 and 12 months.
authors: University of Connecticut Health Center, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada. Electronic address: strober@uchc.edu.
authors: Bruce E
authors: BE
authors: Strober
authors: Innovaderm Research Inc, Montreal, Quebec, Canada.
authors: Robert
authors: R
authors: Bissonnette
authors: Department of Dermatology, Stanford University, Stanford, California.
authors: David
authors: D
authors: Fiorentino
authors: Department of Dermatology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors: Alexa B
authors: AB
authors: Kimball
authors: Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), Azienda Ospedaliera Papa Giovanni XIII, Bergamo, Italy.
authors: Luigi
authors: L
authors: Naldi
authors: University of Toronto, Toronto, Ontario, Canada.
authors: Neil H
authors: NH
authors: Shear
authors: Janssen Scientific Affairs LLC, Horsham, Pennsylvania.
authors: Kavitha
authors: K
authors: Goyal
authors: Janssen Scientific Affairs LLC, Horsham, Pennsylvania.
authors: Steven
authors: S
authors: Fakharzadeh
authors: Janssen Scientific Affairs LLC, Horsham, Pennsylvania.
authors: Stephen
authors: S
authors: Calabro
authors: Janssen Research and Development LLC, Horsham, Pennsylvania.
authors: Wayne
authors: W
authors: Langholff
authors: Janssen Research and Development LLC, Horsham, Pennsylvania.
authors: Yin
authors: Y
authors: You
authors: Janssen Scientific Affairs LLC, Horsham, Pennsylvania.
authors: Claudia
authors: C
authors: Galindo
authors: Janssen Health Economics and Outcomes Research, Horsham, Pennsylvania.
authors: Seina
authors: S
authors: Lee
authors: Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Mark G
authors: MG
authors: Lebwohl
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000328:Adult; D001688:Biological Products / Q000008:administration & dosage* / Q000494:pharmacology; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy*; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000008:administration & dosage
chemical_list: D001688:Biological Products; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept
keywords: BSA; DLQI; PGA; PSOLAR; Psoriasis Longitudinal Assessment and Registry; adalimumab; biologic; effectiveness; efficacy; etanercept; infliximab; ustekinumab