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Drug survival of fumaric acid esters for psoriasis: a retrospective study
Author(s) -
Ismail N.,
Collins P.,
Rogers S.,
Kirby B.,
Lally A.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12849
Subject(s) - psoriasis , drug , medicine , fumaric acid , retrospective cohort study , dermatology , pharmacology , chemistry , organic chemistry
Summary Background Fumaric acid esters ( FAE s) have been used for over 30 years in the management of psoriasis. Objectives To determine drug survival of FAE s in patients with psoriasis, treatment‐limiting adverse drug events and the range of effective drug doses. Methods A retrospective, single‐centre study assessing all patients commenced on FAE s between October 2003 and July 2012. Demographic data, length of treatment, reasons for discontinuation of FAE s, side‐effects and range of doses were recorded. Results Two hundred and forty‐nine patients [160 (64%) male] were included. The mean age at which FAE s were commenced was 44·5 years (range 17–82 years). The mean length of treatment was 28 months (range 1 week to 106 months). In patients who were commenced on FAE s ≥ 4 years before inclusion in this study, the 4‐year drug survival was 60% (64/107). FAE s were discontinued in 146/249 patients (59%); this was due to lack of efficacy in 59/146 (40%) and gastrointestinal upset in 39/146 (27%). A very low dose of FAE s (< 240 mg daily) was successful in maintaining control of psoriasis in 26 (10%) patients. The mean treatment duration of these patients was 64 months (range 32–106 months). Conclusions Fumaric acid esters have a 4‐year drug survival rate of 60%, which compares favourably with reported 4‐year survival rates of 40% for etanercept and adalimumab and 70% for infliximab. Longer drug survival is more likely in the significant subgroup of patients in whom a very low dose of FAE s is sufficient to control disease. The reasons for this are unclear.