P40 Suboptimal clinical and quality of life outcomes in psoriasis patients: an evaluation of treatment patterns among the conventional systemic cohort of the British Association of Dermatologists Biologic and Immunomodulators Register
Journal: British Journal of Dermatology (2024)

Abstract Moderate-to-severe psoriasis can be managed with conventional systemic (CS), targeted synthetic and biologic therapies. A stepwise treatment ladder paradigm is the standard of care, with CS typically prescribed first. CS exposure may be prolonged without formal guidance on treatment failure within a defined follow-up period, contrasting with specific guidance for biologics. A 2018–2019 global survey found non-switchers primarily on oral CS persisted &amp;gt;9 months despite greater disease severity and lower quality of life (QoL) post-initiation (Thai S, Barlow S, Lucas J, et al. Suboptimal clinical and quality of life outcomes in patients with psoriasis undertreated with oral therapies. Dermatol Ther 2023;13:1289–303); suboptimal treatment of psoriasis patients is not greatly understood. Using the UK and Ireland’s BADBIR CS cohort 2008–2022 (Amgen-sponsored), we retrospectively assessed treatment patterns and effects (PASI, PGA and DLQI) over time in routine clinical practice. Persistence was evaluated overall and at 6- and 12-month intervals. Effects were assessed at baseline, 6- and 12-months post-initiation among patients with non-missing data. 5662 patients enrolled in the BADBIR CS cohort. Most patients commenced methotrexate (n = 2822, 49.8%), ciclosporin (n = 1517, 26.8%) and acitretin (n = 1244, 22.0). Among completed therapy cycles, the mean overall length of persistence regardless of treatment was 15.9 (SD = 18.7) months. Proportions of patients that persisted at each of these intervals post-initiation were: 99.7% (n = 5646) at 6 months, 83.7% (n = 4739) at 12 months, 72.2% (n = 4088) at 24 months, 54.7% (n = 3096) at 36 months, 42.2% (n = 2387) at 48 months, 33.6% (n = 1900) at 60 months, and 27.6% (n = 1560) &amp;gt;60 months. At baseline (n = 4725), 85.0% of patients had severe disease (PASI &amp;gt; 10) and 10.6% had moderate (PASI 5–10). At 6 months (n = 3465), 25.8 and 25.6% had severe and moderate disease, respectively. At 12 months (n = 2926), 21.1 and 27.3% had severe and moderate disease, respectively. At baseline (n = 4228), 88.7% of patients reported very-to-extreme impact on QoL (DLQI ≥ 11) and 6.3% reported moderate impact (DLQI 6–10). At 6 months (n = 2959), 33.0 and 19.6% reported very-to-extreme and moderate impact on QoL, respectively. At 12 months (n = 2613), 28.6 and 19.6% reported very-to-extreme and moderate impact on QoL, respectively. Findings suggest that despite suboptimal clinical and QoL outcomes after 6 months, most patients persisted on CS beyond 12 months, with a quarter persisting &amp;gt;5 years. Long-term exposure to some CS may also increase the risk of toxicity. Defining treatment failure within a specific follow-up period for CS may result in earlier switches to targeted systemic therapies. Stringent guidance earlier in the treatment paradigm would greatly benefit patients with moderate-to-severe psoriasis and their treatment journey.