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Comparative effectiveness of biological therapies on improvements in quality of life in patients with psoriasis
Author(s) -
Iskandar I.Y.K.,
Ashcroft D.M.,
Warren R.B.,
Lunt M.,
McElhone K.,
Smith C.H.,
Reynolds N.J.,
Griffiths C.E.M.
Publication year - 2017
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.15531
Subject(s) - medicine , ustekinumab , dermatology life quality index , adalimumab , psoriasis , etanercept , interquartile range , quality of life (healthcare) , cohort , prospective cohort study , cohort study , psoriasis area and severity index , physical therapy , dermatology , disease , rheumatoid arthritis , nursing
Summary Background Evidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life ( HRQ oL) in routine clinical practice is limited. Objectives To examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQ oL in patients with psoriasis, and to identify potential predictors for improved HRQ oL. Methods This was a prospective cohort study in which changes in HRQ oL were assessed using the Dermatology Life Quality Index ( DLQI ) and EuroQoL‐5D ( EQ ‐5D) at 6 and 12 months. Multivariable regression models were developed to identify factors associated with achieving a DLQI of 0/1 and improvements in the EQ ‐5D utility score. Results In total, 2152 patients with psoriasis were included, with 1239 patients on adalimumab, 517 on etanercept and 396 on ustekinumab; 81% were biologic naïve. For the entire cohort, the median (interquartile range) DLQI and EQ ‐5D improved from 18 (13–24) and 0·73 (0·69–0·80) at baseline to 2 (0–7) and 0·85 (0·69–1·00) at 6 months, respectively ( P < 0·001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female sex, multiple comorbidities, smoking and a higher DLQI or a lower EQ ‐5D utility score at baseline predicted a lower likelihood of achieving a DLQI of 0/1 or improvement in the EQ ‐5D. Compared with adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biological therapies in EQ ‐5D improvement. Conclusions In routine clinical practice biological therapies produce marked improvement in HRQ oL, which is influenced by the choice of biological therapy, baseline impairment in HRQ oL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biological therapy for patients related to improvements in HRQ oL.