Treatment patterns of systemic drug use in Japanese patients with plaque psoriasis: A retrospective chart review

Abstract

Plaque psoriasis (PsO) is a chronic immune-mediated inflammatory disease with skin lesions accompanied by an inflammation-related comorbidity risk. The development of various oral drugs and biologics for PsO has provided increasing systemic treatment options for patients with PsO, and the guidance regarding the use of biologics and PsO treatment schemes are widespread in Japan. However, no comprehensive guidelines regarding systemic drug use are available, and the current treatment patterns of systemic drugs for PsO in Japan remain unclear. We conducted a retrospective chart review to clarify the current treatment patterns of systemic drugs for PsO. We enrolled 114 patients who started systemic drugs for PsO between January 2017 and December 2020 at four institutes, with a mean follow-up of 37.2 months. The mean disease duration was 7.8 (standard deviation 9.5) years at the systemic drug initiation. Of all the patients, 78.1% started with oral drugs (phosphodiesterase [PDE] 4 inhibitors 56.1%. calcineurin inhibitors 14.0%. vitamin A derivatives 7.9%), whereas 21.9% started with biologics (interleukin [IL]-17 inhibitors 9.6%. tumor necrosis factor inhibitors 7.0%. IL-23 inhibitors 3.5%. IL-12/23 inhibitors 1.8%). Oral drugs had shorter drug persistence than biologics: the 12-month persistence of the oral drugs vitamin A derivative, calcineurin inhibitor, and PDE4 inhibitor, was 35.5%, 25.8%, and 60.1%, respectively, compared with that of the biologics IL-23 and IL-17 inhibitors, which was 85.6% and 84.7%, respectively. During the study period, the incidence of treatment changes was 59.1/100 patient-years. Lack of efficacy was the most common reason for treatment changes from monotherapy (34.1%). This retrospective medical chart review allowed us to understand the real-world, long-term treatment patterns of systemic drugs for PsO and the relationships between the reasons for treatment changes and subsequent treatment selection, indicating that there is still room for improvement in the appropriate use of systemic drugs for PsO in Japan.

Keywords: PDE4 inhibitor; biologics; psoriasis; systemic drug; treatment pattern.

FIGURE 1

Persistence of systemic treatment (drug survival). Kaplan–Meier survival analysis to analyze curves for drug survival persistence analysis. (a) Persistence of initial systemic drugs started during the study (in more than 10 patients) and (b) persistence of all systemic drugs followed up during the study period (in more than 10 patients). The number of patients at risk for each systemic drug is shown below the time point of the x axis. CaN, calcineurin; i, inhibitors; IL, interleukin; PDE4, phosphodiesterase 4; TNF, tumor necrosis factor; Vit A deriv, vitamin A derivatives.

FIGURE 2

Durations of interruption after the ceasing of systemic drugs. Within each box, vertical black lines represent median values. Boxed extended from the first quartile (Q1) to third quartile (Q3) of data distribution of interruption period for each systemic drug. Lower whiskers represent minimum observation values above the lower fence [Q1 − 1.5 times interquartile range (IQR)], and upper whiskers represent maximum observation values above upper fence (Q3 + 1.5 times IQR). Dots denote outliers. CaN, calcineurin; i, inhibitors; IL, interleukin; PDE4, phosphodiesterase 4; TNF, tumor necrosis factor; Vit A deriv, vitamin A derivatives.