title: Drug survival rates and reasons for drug discontinuation in psoriasis.
abstract: OBJECTIVE
  Moderate-to-severe psoriasis frequently requires long-term systemic therapy. Reflecting efficacy, safety, and treatment satisfaction, drug survival is an indicator of therapeutic success. The objective of the present study was to assess drug survival rates and reasons for discontinuation of fumaric acid esters (FAE), methotrexate (MTX), acitretin (ACI), cyclosporine A (CyA), adalimumab (ADA), etanercept (ETA), infliximab (INF), and ustekinumab (UST) in patients with moderate-to-severe psoriasis.
  
  
  METHODS
  We performed a retrospective analysis of 373 patients who had received a total of 696 treatment courses at a German university hospital in the period 1/2003-5/2014.
  
  
  RESULTS
  The crude probability of survival was highest for UST, followed by ADA, ETA, INF, FAE, MTX, ACI, and CyA. In multivariate regression analysis using FAE as reference, hazard ratios (HR) for discontinuation were 0.14 (95 % confidence interval: 0.06-0.35) for UST, 0.43 (0.26-0.73) for ADA, 2.11 (1.14-3.91) for ACI, and 3.26 (1.44-7.39) for CyA. INF showed longer survival when combined with MTX (HR 2.87, 1.21-6.81). Traditional systemic antipsoriatic agents as well as INF were most frequently discontinued due to adverse events; all other biologics, due to inefficacy with respect to cutaneous lesions.
  
  
  CONCLUSIONS
  Drug survival rates should be integrated into therapeutic decisions in order to provide patients with an optimal long-term strategy.
authors.affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Arnold
authors.affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Marthe-Lisa
authors.initials: ML
authors.lastname: Schaarschmidt
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Herr
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Sergij
authors.initials: S
authors.lastname: Goerdt
authors.affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.|Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
authors.forename: Wiebke K
authors.initials: WK
authors.lastname: Peitsch
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015984:Causality; D015897:Comorbidity; D003879:Dermatologic Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents