ABSTRACT
Secukinumab is a fully human anti-interleukin-17A monoclonal antibody for the treatment of moderate-to-severe plaque psoriasis. In a previous analysis of the ongoing, longitudinal pharmacovigilance register BADBIR (data cutoff 31 August 2020), secukinumab showed sustained drug survival over 24 months in biologic-naive patients (86%) comparable to that of biologic-naive patients treated with ustekinumab (84%) and greater than that of biologic-naive patients treated with adalimumab (71%). In this updated analysis, we report drug survival for a larger cohort of biologic-naive and biologic-experienced patients with psoriasis treated with secukinumab (- data cutoff 31 August 2021). Patients prescribed secukinumab at baseline (biologic-naive) or after switching therapies during follow-up (biologic-experienced) were included. Drug survival up to 24 months (Kaplan-Meier method) was defined as the duration between date of first secukinumab exposure and date of stopping secukinumab or the end of the study censoring period. Data from 2850 patients were analysed (949 biologicnaive;1901 biologic-experienced). Mean duration of followup was 2.9 years (median 2.9 years) for biologic-naive and 2.7 years (median 2.5 years) for biologic-experienced patients. Among biologic-naive and biologic-experienced patients, respectively, most were male (61.3% and 55.6%), mean age was 46.5 and 45.1 years, mean body mass index was 31.6 and 32.5 kg m-2, mean age of disease onset was 25.6 and 23.7 years, and mean disease duration was 20.9 and 21.4 years. For biologic-experienced patients, the mean (SD) number of prior biologics received was 1.8 (1.0). Fewer biologicnaive patients had psoriatic arthritis (21.2% vs. 33.2%) and had received prior ciclosporin (50.1% vs. 60.1%), and prior methotrexate use was similar between subgroups (74.3% vs. 76.8%). Overall drug survival for biologic-naive and biologicexperienced patients was comparably high after 12 months (89% vs. 78%) and 24 months (78% vs. 62%). Drug survival for biologic-experienced patients was similar to that previously reported [77% (12 months) and 59% (24 months)]. With a median follow-up of 2.9 and 2.5 years for biologic-naive and biologic-experienced patients, respectively, these data represent the longest follow-up of any BADBIR analysis to date supporting and extending previous findings of sustained drug survival of secukinumab in patients with moderate-to-severe plaque psoriasis in real-world practice. As expected, drug survival was higher in patients who initiated secukinumab at baseline than those who switched to secukinumab after other biological therapy. However, overall drug survival of 78% and 62% at 12 and 24 months in biologic-experienced patients was similar to that reported previously [77% (12 months) and 59% (24 months)], and just slightly lower than was reported before the COVID-19 pandemic [81% (12 months) and 63% (24 months)].
ABSTRACT
Background: The psychological impact of breast cancer diagnosis and management are well known, and the COVID-19 pandemic may have exacerbated this distressing experience for these patients. Objective(s): We aimed to assess the supportive care outcomes and level of psychological distress experienced by breast cancer patients in our regional survivorship clinic during the COVID pandemic, in comparison to a pre-pandemic population. We also sought to determine whether using telehealth during the pandemic was preferred by oncology patients. Method(s): All 49 patients who attended the breast cancer survivorship clinic in 2019, and 50 patients who attended in 2021, were included in this study. Deidentified data was collected from the end of treatment care plan.We also collected self-reported scores on The National Comprehensive CancerNetwork Distress Thermometer (DT). Patients with a self-reported DT score >4 were asked to complete the Kessler Psychological Distress Scale questionnaire as a secondary assessment of depression and anxiety. Result(s): Breast cancer patients in the 2021 pandemic cohort recorded higher levels of distress (4.2/10) on the Distress Thermometer compared to the 2019 pre-pandemic cohort (2.4/10) (p = 0.0007). In the pandemic cohort, 38% of breast cancer patients reported a K10 score >16 indicating a moderate-to-high or threefold population risk of having a current anxiety or depressive disorder, compared with 12% of the patients in the pre-pandemic cohort. Patients in the prepandemic group most commonly identified physical concerns including fatigue (61%), poor sleep (43%), pain (33%) and neuropathy (31%). The key concerns of patients in the 2021 group were fatigue, anxiety, depression and fear of recurrence. This study demonstrated the use of supportive care tools to identify breast cancer patients who are vulnerable to increased psychological distress during the COVID pandemic. It also highlights the need to address the limited access to psychological support services for cancer patients in Gippsland.
ABSTRACT
Background/Aims Treatment guidelines for psoriatic arthritis consider both skin and joint involvement and recommend collaborative multidisciplinary team (MDT) working when selecting therapy. However, multidisciplinary practice for psoriatic disease (PD) has not been well studied, with little data on service models and current practice. This survey explored collaborative working in PD treatment by rheumatology and dermatology healthcare professionals (HCPs) to provide a better understanding of current working patterns, collaborating specialties, as well as benefits and challenges of combined clinics for PD management. Methods An online survey was emailed to rheumatology and dermatology HCPs using professional networks. We requested information on role, collaborating specialties, benefits and barriers to collaborative working in PD, and the impact of COVID-19. The ideal service model and additional comments completed the survey. Results We received 80 responses between October 2020 and April 2021, covering England, Wales, Scotland and Northern Ireland. Of these, 56 respondents (70.0%) were consultants, 22 (27.5%) clinical nurse specialists and one each a lead pharmacist (1.3%) and specialist registrar (1.3%). Rheumatology HCPs accounted for 40.0% of respondents (n=32) and dermatology HCPs for 60.0% (n=48). As part of their PD MDT, most respondents (n=60, 75.0%) worked collaboratively with other specialties. Combined clinics, whether virtual, face to face or an MDT, accounted for 51.5% of collaborative working for rheumatology HCPs and 58.9% for dermatology HCPs. Collaboration with other specialists mainly occurred by email or written referrals (Table 1). The most important perceived benefits of combined clinics were shared knowledge, better patient outcomes and patient satisfaction. The biggest challenges to setting up combined clinics were job plan time (rated as 'difficult' or 'very difficult' by 78.8% of respondents), logistics (67.5%) and unsupportive senior management (66.3%), while 77.5% felt COVID-19 had partial or significant impact on combined clinics. Conclusion This is the first survey to explore UK collaborative working in PD. Approaches varied, with different models of working and little consistency. While HCPs appreciated the benefits of collaborative working, numerous challenges in establishing formal arrangements were identified. More evidence is needed to demonstrate the perceived benefits of collaborative working in improving patient outcomes by standardising best practice.