Failure of Biologic Therapy in Psoriasis.

OBJECTIVE: This study aims to describe the frequency of biologic therapy failure in psoriasis patients along with associated patient demographics and characteristics. METHODS: This was a retrospective medical-record review of psoriasis patients evaluated from January 1st, 2013, through May 1st, 2018, and who failed at least once to adhere to their biologic therapy. RESULTS: Seventy-seven patients with psoriasis who had discontinued biologic therapy at least once were included in this study. Hypertension (58.4%), diabetes (37.7%), dyslipidemia (27.3%), and psoriatic arthritis (23.4%) were the main comorbidities observed. Adalimumab (ADA, 80.5%), ustekinumab (UST, 70.1%), and etanercept (ETA, 14.2%) were the most frequently used biologics in our cohort. The biologic with the longest mean duration of use prior to its discontinuation was UST (17.0 months), followed by ADA (15.9 months) and ETA (13.6 months). CONCLUSION: The most common reason for discontinuing biologic therapy was that said therapy was not effective, though for ETA and UST, the fact that biologic therapies are not universally covered by insurance company was found to be associated with their discontinuation, as well. There were no statistically significant associations found between biologic therapy discontinuation and age, gender, or comorbidities, which last included obesity, class I. Larger studies are warranted to identify risk factors associated with biologic therapy failure to help guide drug selection, decrease morbidity associated with such nonadherence and improve patient outcomes.

Mycosis Fungoides in Puerto Rico: A 15-year Follow-up Retrospective Study.

OBJECTIVE: To describe the patient population with mycosis fungoides (MF) in Puerto Rico in terms of demographics, disease course, and management. METHODS: We performed a retrospective chart review of patients with MF who were being followed at the University of Puerto Rico dermatology clinics from 1999 through 2016. Collected data included demographics, age at diagnosis, stage at diagnosis, follow-up time, treatment, and stage at the time of the study. RESULTS: A total of 53 patients were diagnosed with MF from 1999 through 2016, with a mean follow-up period of 89 months. Of those, 45% were male. At the time of diagnosis, 40% were at stage 1A, 53% were at stage 1B, and 7% were at stages 2 to 4. During data collection, 74% of the patients remained stable, 18% improved clinically, and 8% progressed in disease stage. The treatment modalities used included phototherapy, topical steroids, topical and systemic retinoids, methotrexate, topical and systemic chemotherapy, and interferon. CONCLUSION: Our study reflects the chronic and indolent course of MF, which has an overall good prognosis if diagnosed at an early stage, as has been demonstrated in the recent literature. The information contained within this manuscript should contribute to the understanding and characterization of MF in patients in Puerto Rico.