(039) Treatment Patterns in Moderate to Severe Psoriasis: A Hospital-based Retrospective Analysis

Background: Psoriasis is a skin disease affecting between 0.8% and 4.5% of the worldwide population. For moderate to severe psoriasis, according to current European and Italian clinical guidelines, biologicals (e.g., adalimumab and etanercept) should be prescribed after at least one traditional systemic treatment (e.g., methotrexate and cyclosporine) has failed.

Objectives: This study aims to investigate the therapeutic patterns of patients affected by moderate to severe psoriasis, including the length of treatment and the factors that led to any treatment.

Methods: We conducted a retrospective study on adult patients with moderate to severe psoriasis who were treated at the Dermatological Unit of Sant’Orsola Hospital in Bologna. They had been followed for at least one year and had received at least one biological treatment. Demographic and clinical variables (e.g., comorbidities, treatments, health habits) were collected between April and July 2023 from the patients’ health records and described through percentage frequencies. Treatment patterns were studied through trajectory analysis, and treatment duration was assessed using the Kaplan-Meier estimator.

Results: Patients eligible for this study were 400. The majority were male (63%) and middle-aged (median 56 years, interquartile range 43-65 years). The main comorbidities were psoriatic arthropathy (30%), dyslipidemia (29%), and hypertension (29%). A family history of psoriasis was present in 32% of patients. The most used traditional agents were ciclosporin (73% of patients), methotrexate (61%), acitretin (18%) and the most used biologics were adalimumab (35%), secukinumab (31%) and etanercept (20%). The choice of second treatment depended on the initial traditional agent used. After ciclosporin, patients switched to both methotrexate and biologics, while after methotrexate, a switch to biologicals was mainly observed. The mean duration of treatment with the three most used biologicals was two years and a half. No difference in length of treatment courses was observed according to sex, except for adalimumab for which treatment duration was shorter among women. Among patients who ceased using biological treatments, 84% of those on etanercept and 71% of those on adalimumab and secukinumab discontinued because of lack of efficacy.

Conclusions: In accordance with clinical guidelines, most of the patients were initially treated with traditional agents before switching to biologicals. The most prescribed biologicals had similar treatment durations, with discontinuation primarily attributed to their ineffectiveness. Understanding how gender may impact the length of treatment can lead to more personalized and effective treatments for individuals.