Abstract
Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias (HUCA Dermatology Department, and to identify the predictors of drug discontinuation. Materials and Methods: A retrospective hospital-based study, including data from 148 patients who were receiving ustekinumab (Stelara®) between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan–Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months (SD 32.63 months; median 41 months). The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months (95% confidence interval. CI 36.9 to 123.01 months). The survival study revealed statistically significant differences between patients with arthritis (log-rank test, p < 0.001) and those who had previously received biological treatment (log-rank test, p = 0.026). The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis.
Highlights
Psoriasis [1] is a chronic inflammatory disease of the skin
Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. 95% confidence intervals are provided
We present a retrospective study in which we assess the overall survival of the drug ustekinumab, based on data collected over 10 years and 10 months in the HUCA Dermatology Department
Summary
In which the genetic susceptibility of an individual interacts with environmental factors to produce dysregulation of the immune system [2] It is characterized by a greater level of proliferation of keratinocytes and by the infiltration of immunocompetent cells in the epidermis and dermis. It affects approximately 2% of the world’s population At present, it is considered a systemic disease with predominantly cutaneous manifestations and is associated with psoriatic arthritis in up to 30% of cases [3]. It is considered a systemic disease with predominantly cutaneous manifestations and is associated with psoriatic arthritis in up to 30% of cases [3] It has two periods of highest incidence, from 20 to 30 years, and from 50 to 60 years [4].
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