Abstract
OBJECTIVES: Psoriasis and psoriatic arthritis (PsA) are independently associated with comorbidities, including obesity and metabolic syndrome, which may impact treatment outcomes. This study aimed to assess baseline differences between patients with plaque psoriasis alone and those with concomitant PsA, and to investigate the impact of these characteristics on ustekinumab (UST) persistence and outcomes.
METHODS: 9057 patients receiving UST or conventional systemic disease-modifying antirheumatic drugs were selected from the British Association of Dermatologists Biologic and Immunomodulators Register. The psoriasis and PsA cohorts were compared at baseline. Time to discontinuation during 10-year follow-up was assessed using multivariable Cox regression and Kaplan-Meier analyses, stratifying for interacting covariates and PsA status. Generalised linear mixed models assessed the impact of baseline characteristics on Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index over time.
RESULTS: Greater comorbidity burden, including hypertension, diabetes, obesity and depression, and greater inability to work were observed in the PsA cohort than in the psoriasis cohort. PsA (HR 1.98), female sex (HR for male sex 0.72) and depression (HR 1.21) were associated with shorter UST persistence. PsA showed a differential association with UST persistence by PASI strata and prior biologic exposure. Quality of life was negatively impacted by depression and PsA.
CONCLUSIONS: The negative impact of comorbidities on treatment persistence identified in this study emphasises the need for patient-centric, multidisciplinary care in screening for and managing comorbidities in psoriasis and PsA treatment. Psychological support and lifestyle management of modifiable risk factors, including obesity, should be considered.
| Original language | English |
|---|---|
| Article number | e002533 |
| Number of pages | 9 |
| Journal | RMD Open |
| Volume | 9 |
| Issue number | 1 |
| Early online date | 17 Jan 2023 |
| DOIs | |
| Publication status | Published - 14 Feb 2024 |
Acknowledgements
The authors thank the patient participants, without whom the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) would not be possible. We thank all the healthcare professionals who support the BADBIR and provide the data to the registry. We acknowledge the significant contribution made by the BADBIR team regarding their ongoing stewardship of the BADBIR project. Medical writing and administrative support were provided by Rebecca Howard, BSc (Hons), and Stacey Osafo, MRes, at OPEN Health Communications, which was funded by Janssen-Cilag Ltd.Funding
This work was supported by Janssen-Cilag Ltd.
| Funders | Funder number |
|---|---|
| Janssen Cilag Ltd | |
| Rebecca Howard |
Keywords
- arthritis, psoriatic
- biological therapy
- therapeutics
ASJC Scopus subject areas
- Rheumatology
- Immunology and Allergy
- Immunology
