A Retrospective Review of Patients' Response to Biologic Therapy for Psoriasis.

BACKGROUND: Biologic treatments have taken the forefront in treating moderate-to-severe psoriasis. Although numerous randomized, controlled trials have demonstrated the efficacy of these agents, there is limited data suggesting that clinical trial outcomes are reproducible in real-world patients. OBJECTIVE: Obtain real-world evidence for the use of biologics that target different segments of the immune system in patients with moderate-to-severe psoriasis. METHODS: A retrospective chart review was conducted for 100 patients who initiated biologic therapy and had a follow-up visit within a 4- to 12-month period. Efficacy assessments included body surface area (BSA), Physician’s Global Assessment (PGA) scores, composite BSA×PGA scores, and the National Psoriasis Foundation (NPF) Treat to Target (TTT) goal of ≤1% BSA. RESULTS: Biologic treatment led to notable reductions in BSA, PGA, and BSA×PGA relative to baseline, with the majority (67.0%) of the population achieving NPF TTT goals at follow-up. Disease improvements were observed in all patients, regardless of baseline body weight, prior experience with biologics, or the specific immune target of the prescribed biologic. CONCLUSION: Long-term biologic therapy demonstrated effectiveness in treating patients with moderate-to-severe psoriasis. J Drugs Dermatol. 20(4):442-449. doi:10.36849/JDD.2021.5823Visit the Psoriasis Resource Center for more.

Apremilast with Add-On Calcipotriene/Betamethasone Dipropionate for Treating Moderate to Severe Plaque Psoriasis.

BACKGROUND: About 20% of patients taking apremilast alone obtain PASI 75 by week 8. This single-center, pilot study aimed to determine whether add-on topical therapy with calcipotriene/betamethasone dipropionate (C/BD) could improve responses of partial apremilast responders by week 12. METHODS: Adults (≥18 years of age) with moderate to severe plaque psoriasis (baseline PGA ≥3, BSA affected ≥10%, PASI ≥12) took oral apremilast (30 mg twice daily) for 8 weeks. Patients who achieved between PASI 25–74 at week 8 used add-on, daily topical C/BD (.005%/.064%) foam up to week 12; those with <PASI 25 at week 8 were discontinued. RESULTS: Of 50 patients enrolled, 26 achieved PASI 25−74 and 8 PASI 75 at week 8. At week 12, 29 achieved PASI 75, and 24 at week 16. Of the week-8 partial responders, 21/26 achieved PASI 75 at week 12 on combination therapy and 15 maintained PASI 75 through week 16 on apremilast alone (4 did not maintain; 2 lost to follow up). In partial responders, mean PGA and BSA affected improved by 30% and 33% on apremilast, respectively, and by 67% and 86% at week 12 on the combination therapy, respectively. The most commonly reported adverse events (AEs; >5% occurrence) were headache (14%), diarrhea (10%), and nausea (8%); majority were mild. No related serious AEs occurred. CONCLUSION: We show that most week-8 partial apremilast responders can achieve PASI 75 at week 12 with combination C/BD topical therapy, and maintain PASI 75 through week 16 with apremilast monotherapy. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5435.

Adjunctive Use of Calcipotriene/Betamethasone Dipropionate Foam in a Real-World Setting Curtails the Cost of Biologics Without Reducing Efficacy in Psoriasis.

INTRODUCTION: Although the efficacy of monotherapy with biologics for psoriasis is well established, many patients fail to achieve complete plaque clearance from their initial biologic treatment alone. Adjunctive treatment with topical calcipotriene plus betamethasone dipropionate (Cal/BD) foam may offer substantial clinical benefit and potential cost savings. METHODS: We conducted a 16-week, open-label, single-arm study of adjunctive therapy with Cal/BD foam in subjects who had been treated with etanercept or adalimumab for ≥ 24 weeks but had not obtained a satisfactory treatment response. Assessments included affected body surface area (BSA), Physician's Global Assessment (PGA) of disease severity, BSA × PGA, National Psoriasis Foundation (NPF) Treat to Target status, and likelihood of the physician to switch biologics. In parallel, a cost analysis was performed to compare the cost of switching to a different biologic versus adding Cal/BD foam to the original biologic. RESULTS: Four weeks of daily adjunctive treatment with Cal/BD foam led to notable reductions in BSA, PGA, and BSA × PGA relative to baseline. Additionally, by week 4, > 75% of subjects achieved NPF Treat to Target status, and the likelihood of the investigator to switch biologics decreased from 90.0% at baseline to 7.1%. The improved efficacy was maintained throughout the additional 12 weeks of maintenance Cal/BD foam application. The pharmacoeconomic evaluation demonstrated that adjuvant use of Cal/BD foam led to cost savings compared with switching biologic treatments. LIMITATIONS: Due to the nature of the open-label study lacking a vehicle-treated control, no statistical comparison can be made. CONCLUSIONS: The results of this study demonstrate that the addition of Cal/BD foam to plaque psoriasis patients who still have significant disease activity despite being on stable biologic therapy improves treatment outcomes to the point where switching to a more expensive biologic therapy is a less suitable treatment option.