Anti-TNF-α psoriasis treatment is inefficacious over time
MedWire News: The overall efficacy of tumor necrosis factor (TNF)-α inhibitors for the treatment of psoriasis diminishes with time, as indicated by the progressive loss of patient adherence to the treatment, say Danish researchers.
Their findings show that predictors of poor adherence to anti-TNF-α's include female sex, the type of anti-TNF-α agent taken, and whether patients have experienced previous anti-TNF-α inefficacy.
The drug with the best patient retention in the study cohort was infliximab, notes the team in the British Journal of Dermatology.
"Long-term psoriasis control is not only a desirable clinical objective, but a sound strategy from the pharmacoeconomic perspective," write Robert Gniadecki (Bispebjerg University Hospital, Copenhagen) and colleagues.
"Initiating a therapy with a drug that eventually will lose its efficacy increases the overall cost of therapy," they add.
Gniadecki et al used data from the Danish DERMBIO database to investigate adherence to anti-TNF-α's among 747 psoriasis patients treated during 882 treatment series with etanercept (n=311 series), adalimumab (N=427 series), or infliximab (n=144 series).
Analysis revealed that the strongest predictor of drug adherence was the previous failure (in efficacy) of an anti-TNF-α agent, which increased the odds of treatment discontinuation more than five-fold.
To test the efficacy of each drug individually, the researchers carried out analysis on anti-TNF-α-naïve patients (n=564). The drug with the longest adherence was infliximab, with 4-year adherence rates of 70% compared with 40% for etanercept or adalimumab.
In patients with a previously failed anti-TNF-α drug experience, adherence to treatment was very poor, with a 4-year adherence rate of less than 10%.
Adverse event rates were comparable across all the treatments, note Gniadecki and team, at 39.8% for adalimumab, 39.2% for etanercept, and 38.2% for infliximab. The most common adverse event was infection, with no difference in frequency between the drugs.
The finding that infliximab is considered superior by patients compared with other anti-TNF-α treatments are "surprising," remark the researchers, in light of their considered inferiority in the treatment of rheumatoid arthritis.
However, they believe it will be worthwhile to explore the reasons for this preference "and further optimize the treatment with the subcutaneously administered anti-TNF-α agents."
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By Sarah Guy