In:
Dermatology, S. Karger AG, Vol. 237, No. 3 ( 2021), p. 338-346
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Obesity is associated with an increased risk of psoriasis. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In this cohort study, we compared obese (BMI ≥30 kg/m 〈 sup 〉 2 〈 /sup 〉 ) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36–56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients ( 〈 i 〉 p 〈 /i 〉 & #x3c; 2.10 〈 sup 〉 –4 〈 /sup 〉 ) and was worse for obese than non-obese patients for UST ( 〈 i 〉 p 〈 /i 〉 = 0.009) and ETA ( 〈 i 〉 p 〈 /i 〉 = 0.02), with no difference for ADA ( 〈 i 〉 p 〈 /i 〉 = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23–2.96], 〈 i 〉 p 〈 /i 〉 = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04–2.19). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes.
Type of Medium:
Online Resource
ISSN:
1018-8665
,
1421-9832
Language:
English
Publisher:
S. Karger AG
Publication Date:
2021
detail.hit.zdb_id:
1482189-8
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