Compared with patients with plaque psoriasis alone, those with plaque psoriasis and psoriatic arthritis (PsA) had a greater comorbidity burden and shorter ustekinumab persistence, according to study results published in Rheumatic and Musculoskeletal Diseases Open.
Researchers conducted a retrospective observational cohort study using data from patients in the UK who were enrolled in the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) from July 2009 to October 2020.
Patients with a diagnosis of plaque psoriasis received ustekinumab or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Patients were included in the study if they commenced or switched from another biologic or csDMARD in the previous 6 months.
Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were collected at baseline and every 6 months until 36 months. The PASI score was collected yearly throughout time in the BADBIR.
At baseline, patients with PsA vs psoriasis alone had a greater comorbidity burden and a lower ability to work. Patients with PsA initiating treatment with ustekinumab or a csDMARD had a higher prevalence of diabetes, obesity, and hypertension. However, patients receiving treatment with ustekinumab vs csDMARDs were more likely to have a diagnosis of depression.
During 10-year follow up, the researchers found that treatment continuation was shorter in patients with concomitant PsA than in those with plaque psoriasis alone (hazard ratio [HR], 1.98) and in those with depression (HR, 1.21). Men vs women demonstrated a lower risk for treatment discontinuation (HR, 0.72), and patients with PsA and previous biologic experience vs those who were biologic-naive had a higher risk for discontinuation. Moreover, a PASI score of greater than 3 than that of 3 or lesser at baseline was associated with an increased probability of discontinuation, and more severe skin symptoms at baseline were associated with increased time to discontinuation.
Study limitations included that the socioeconomic status and availability of treatment could not be accounted for and the possibility of unmeasured confounding could not be ruled out. Moreover, the BADBIR database does not capture PsA disease activity or the involvement of specific disease domains. Finally, clinical decisions to discontinue treatment can be based on other factors, such as skin disease severity or intolerance, but researchers only used time to discontinuation as a surrogate measure of efficacy.
“These results [emphasize] that patient-centric, multidisciplinary care needs to be considered to achieve the best possible outcomes in psoriatic disease,” the study authors noted. “Psychological support should be considered as part of patient care because of the impact of psoriatic disease on [quality of life] and the higher likelihood of depression observed in those treated with biologics than in those receiving csDMARDs. Lifestyle advice and weight management should also be considered for patients with psoriatic disease to [optimize] treatment outcomes.”
Disclosure: This study was supported by Janssen-Cilag Ltd. Several authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Tillett W, Ogdie A, Passey A, et al. Impact of psoriatic arthritis and comorbidities on ustekinumab outcomes in psoriasis: a retrospective, observational BADBIR cohort study. RMD Open. Published online January 17, 2023. doi:10.1136/rmdopen-2022-002533