title: Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).
abstract: BACKGROUND
  Treatment modifications, including dose escalations, dose reductions, switches, discontinuations and restarts of biologics may be necessary in the management of psoriasis but the patterns of usage are incompletely defined.
  
  
  OBJECTIVE
  To examine the treatment utilization patterns of adalimumab, etanercept and ustekinumab among biologic-naïve and non-naïve patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR).
  
  
  METHODS
  The study cohort included adults with chronic plaque psoriasis who were followed up for ≥ 12 months. Treatment modifications were assessed during the first year of therapy. The time-trend method, comparing the cumulative dose (CD) patients received with the recommended cumulative dose (RCD), was used to assess dosing patterns. Concomitant use of other systemic treatments was also examined.
  
  
  RESULTS
  In total, 2980 patients (adalimumab: 1675; etanercept: 996; ustekinumab: 309) were included; 79·2% were biologic-naïve. Over 12 months, 77·4% of patients continued the biologic, 2·6% restarted therapy after a break of ≥ 90 days, 2·5% discontinued, and 17·5% switched biologic therapy. Most patients (85·7%) received the RCD of the biologic, although 8·1% were exposed to a higher CD. In total, 749 (25·1%) patients used conventional systemic therapies concomitantly with a biologic at some stage; methotrexate was used most commonly (458; 61·2%). Of those using combination therapy, 454 (60·6%) continued the use of the conventional systemic therapy for > 120 days after the start of the biologic.
  
  
  CONCLUSIONS
  More than one-third of patients experienced treatment modifications within the first year of initiating a biologic. Conventional systemic therapies, particularly methotrexate, were commonly used concurrently, which should be considered when evaluating treatment response and adverse events to biologics in real-world observational studies.
authors: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester, Manchester Academic Health Science Centre, Room 1·134, 1st Floor, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.
authors: I Y K
authors: IYK
authors: Iskandar
authors: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester, Manchester Academic Health Science Centre, Room 1·134, 1st Floor, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.
authors: D M
authors: DM
authors: Ashcroft
authors: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
authors: R B
authors: RB
authors: Warren
authors: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
authors: I
authors: I
authors: Evans
authors: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
authors: K
authors: K
authors: McElhone
authors: Department of Dermatology, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, U.K.
authors: C M
authors: CM
authors: Owen
authors: Department of Dermatology, Western Infirmary, Glasgow, U.K.
authors: A D
authors: AD
authors: Burden
authors: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K.
authors: C H
authors: CH
authors: Smith
authors: Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, U.K.|Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K.
authors: N J
authors: NJ
authors: Reynolds
authors: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
authors: C E M
authors: CEM
authors: Griffiths
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D001691:Biological Therapy / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015331:Cohort Studies; D000072085:Dermatologists; D057915:Drug Substitution / Q000706:statistics & numerical data; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011565:Psoriasis / Q000188:drug therapy*; D012042:Registries; D006113:United Kingdom; D000069549:Ustekinumab / Q000627:therapeutic use
chemical_list: D001688:Biological Products; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept