Original articleComparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting
Section snippets
Study design and participant protection
We conducted a multicenter cross-sectional study to determine the effectiveness of less commonly used systemic monotherapy and commonly used combination therapies for moderate to severe psoriasis. The study was approved by the University of Pennsylvania and University of Utah institutional review boards, and informed consent was obtained from all patients. The study was conducted in accordance with the Declaration of Helsinki and reported in accordance with the Strengthening the Reporting of
Results
The baseline characteristics of 371 patients receiving methotrexate (reference therapy), less common systemic monotherapies, or common combination therapies for the primary indication of plaque psoriasis are summarized in Table I. In addition to having plaque psoriasis, 75 (20.2%) patients also had other types of psoriasis as follows: 38 (10.2%) with scalp, 20 (5.4%) with guttate, 22 (5.9%) with nail, 16 (4.3%) with inverse or genital, 11 (3.0%) with palmar plantar, and 2 (0.5%) with pustular
Discussion
In this comparative effectiveness study of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the real-world clinical setting, we report similar findings to those of our previous study of the effectiveness of common systemic monotherapies and phototherapy.5 Using a single PGA assessment, the proportions of patients achieving clear or almost clear response to treatment were 50% or less for all examined therapies except for adalimumab
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2020, Journal of the American Academy of DermatologyCitation Excerpt :Cyclosporine should be avoided in patients with poor health and in those with risk factors for developing severe adverse effects.112 Recommendations for the use of cyclosporine are outlined in Table X, and the level of evidence of these recommendations is reported in Table XI.33,50,105,112,146-149 The oral retinoid, acitretin, is a vitamin A derivative, and the active metabolite, etretinate, is an oral retinoid that was initially used for psoriasis in the early 1980s.
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Supported by grant RC1-AR058204 and K24-AR064310 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Dr Gelfand), National Psoriasis Foundation Fellowship Award (Dr Takeshita), Dermatology Foundation Career Development Award (Dr Takeshita), and Training Grant T32-AR007465 (Mr Shin and Dr Wang) from the National Institutes of Health. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.
Disclosure: Dr Callis Duffin was an investigator, consultant, and/or speaker for AbbVie, Amgen Inc, ApoPharma, Bristol-Myers Squibb, Celgene, Eli Lilly, Genzyme, Incyte, Janssen, NovoNordisk, Pfizer Inc, and Wyeth, receiving honoraria and/or salary; served on the advisory board of Amgen Inc; and received residency/fellowship program funding from AbbVie and Amgen Inc. Dr Gelfand served as a consultant for AbbVie, Amgen Inc, Celgene Corp, Eli Lilly, Janssen, Merck, Novartis Corp, and Pfizer Inc, receiving honoraria; had grants or has pending grants from AbbVie, Amgen Inc, Eli Lilly, Genentech Inc, Novartis Corp, and Pfizer Inc; and received payment for continuing medical education work related to psoriasis. Dr Kalb served as a consultant for AbbVie, Amgen Inc, Janssen, LEO Pharma Inc, and Stiefel Laboratories Inc, receiving honoraria; served as an investigator for AbbVie, Amgen Inc, Astellas Pharma Inc, and Janssen, receiving honoraria; and served as a speaker for AbbVie, Amgen Inc, Galderma Laboratories LP, Janssen, and Stiefel Laboratories Inc. Dr Krueger served as a consultant for AbbVie, Amgen Inc, and Janssen; had grants or has pending grants from AbbVie and Amgen Inc; and received payment for lectures and travel-related expenses from AbbVie, Amgen Inc, and Janssen. Dr Robertson is employed by the National Psoriasis Foundation, which receives unrestricted financial support from companies that make products used to treat psoriasis and psoriatic arthritis, including AbbVie, Amgen Inc, Eli Lilly, Galderma Laboratories LP, Janssen, LEO Pharma Inc, Pfizer Inc, and Stiefel Laboratories Inc. Dr Schleicher has served as an investigator for Eli Lilly and Merck, receiving honoraria and/or salary; and received payment for lectures from Janssen and Aqua Pharmaceuticals. Dr Sperber is the medical director of Stephens and Associates, served as a consultant for Amgen Inc, and had grants or has pending grants from AbbVie and Janssen. Dr Van Voorhees served on advisory boards for AbbVie, Amgen Inc, Celgene, Janssen, LEO Pharma Inc Novartis Corp, Pfizer Inc, and Warner Chilcott; served as an investigator for AbbVie and Amgen Inc, receiving grants; served as a consultant for Amgen Inc; and receives other income from Merck. Dr Weisman had grants or has pending grants from AbbVie, Braintree Laboratories Inc, Celgene Corp, Cipher Pharmaceuticals Inc, and LEO Pharma Inc; and received payments for lectures from AbbVie and Amgen Inc. Drs Takeshita, Wang, Stierstorfer, Brod, Linn, Shinohara, and Troxel, and Mr Shin have no conflicts of interest to declare.