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Real‐world comparative effectiveness of adalimumab, etanercept and methotrexate: a Swedish register analysis
Author(s) -
Svedbom A.,
Ståhle M.
Publication year - 2020
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.15978
Subject(s) - medicine , adalimumab , etanercept , methotrexate , confounding , dermatology life quality index , psoriasis , psoriasis area and severity index , rheumatoid arthritis , dermatology
Background The advent of biosimilars may render etanercept ( ETN ) and adalimumab ( ADA ) viable alternatives to methotrexate ( MTX ) as first‐line systemics in psoriasis. However, real‐world relative effectiveness data comparing ADA and ETN to MTX are limited. Objective To estimate the relative effectiveness of ADA and ETN compared to MTX . Methods We analysed data from DermaReg, a regional register in Stockholm, Sweden, to estimate drug survival and mean Psoriasis Area and Severity Index ( PASI ) and Dermatology Life Quality Index ( DLQI ) during maintenance treatment. Results A total of 524 patients initiated 727 treatment episodes with ADA , ETN or MTX . After adjusting for confounders, patients treated with ADA had better drug survival ( HR : 0.67; P = 0.003), lower mean PASI (−2.0; P < 0.001) and lower mean DLQI (−0.9; P < 0.001) during maintenance treatment compared to patients treated with MTX . The results for ETN compared to MTX were mixed. After adjusting for confounding, there was no significant difference in drug survival ( HR 1.23; P = 0.082), but patients on ETN had lower mean PASI (−0.7; P = 0.006) during maintenance treatment. Conclusion Adalimumab is superior to MTX in clinical practice whereas the relative effectiveness between ETN and MTX is less clear. This study also highlights the importance of appropriate confounding control in effectiveness analysis.