title: Biologic drug survival in Israeli psoriasis patients.
abstract: BACKGROUND
  Drug survival is defined as the time period of treatment with a certain drug until its cessation. The role of previous exposure to traditional systemic treatments in biologic survival is still unknown.
  
  
  OBJECTIVE
  To investigate the drug survival rates of biologic treatments in patients with psoriasis and to identify predictor factors.
  
  
  METHODS
  Survival analysis was performed on patients with severe psoriasis who received adalimumab, infliximab, etanercept, and ustekinumab for treatment of psoriasis, drawn from the Clalit Health Services database. Multivariate analysis was performed adjusting for demographic variables; metabolic syndrome and its components; psoriatic arthritis; biologic naivety; coadministration of methotrexate, acitretin, or cyclosporine; and previous standard systemic treatment exposure.
  
  
  RESULTS
  Among 907 patients treated with 1575 biologic treatments, ustekinumab had a significantly higher survival rate than tumor necrosis factor inhibitors. Biologic naivety and concomitant methotrexate intake were positive predictors for drug survival, whereas the female sex and the duration of previous systemic treatments were negative predictors.
  
  
  CONCLUSIONS
  Data regarding disease severity or duration could not be drawn from the Clalit Health Services database.
  
  
  CONCLUSIONS
  Ustekinumab had better retention rates in comparison with other investigated biologics in patients with severe psoriasis, most of whom used it as a third line therapy.
authors.affiliation: Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel; Division of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: Guyshal@bgu.ac.il.
authors.forename: Guy
authors.initials: G
authors.lastname: Shalom
authors.affiliation: Department of Research and Information, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
authors.affiliation: Department of Dermatology, Haemek Medical Center, Afula, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Ziv
authors.affiliation: Department of Dermatology, Haemek Medical Center, Afula, Israel.
authors.forename: Cohen Barak
authors.initials: CB
authors.lastname: Eran
authors.affiliation: Chief Physician's Office, Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Feldhamer
authors.affiliation: Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Freud
authors.affiliation: Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel.
authors.forename: Eitan
authors.initials: E
authors.lastname: Berman
authors.affiliation: Rheumatology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
authors.forename: Shirley
authors.initials: S
authors.lastname: Oren
authors.affiliation: Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Emmilia
authors.initials: E
authors.lastname: Hodak
authors.affiliation: Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. Electronic address: levpav@gmail.com.
authors.forename: Lev
authors.initials: L
authors.lastname: Pavlovsky
mesh_terms: D017255:Acitretin / Q000627:therapeutic use; D000068879:Adalimumab / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D016208:Databases, Factual; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D000068800:Etanercept / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000069285:Infliximab / Q000008:administration & dosage* / Q000627:therapeutic use; D053711:Interleukin-12 Receptor beta 1 Subunit / Q000037:antagonists & inhibitors; D007557:Israel; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000069549:Ustekinumab / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D053711:Interleukin-12 Receptor beta 1 Subunit; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D017255:Acitretin; D000068800:Etanercept; D008727:Methotrexate
keywords: adalimumab; biologic medications; drug survival; etanercept; infliximab; psoriasis; ustekinumab