Comparative effectiveness of biological therapies on improvements in quality of life in patients with psoriasis – ScienceOpen
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      Comparative effectiveness of biological therapies on improvements in quality of life in patients with psoriasis

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          Summary

          Background

          Evidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life ( HRQoL) in routine clinical practice is limited.

          Objectives

          To examine the comparative effectiveness of adalimumab, etanercept and ustekinumab on HRQoL in patients with psoriasis, and to identify potential predictors for improved HRQoL.

          Methods

          This was a prospective cohort study in which changes in HRQoL were assessed using the Dermatology Life Quality Index ( DLQI) and EuroQoL‐5D ( EQ‐5D) at 6 and 12 months. Multivariable regression models were developed to identify factors associated with achieving a DLQI of 0/1 and improvements in the EQ‐5D utility score.

          Results

          In total, 2152 patients with psoriasis were included, with 1239 patients on adalimumab, 517 on etanercept and 396 on ustekinumab; 81% were biologic naïve. For the entire cohort, the median (interquartile range) DLQI and EQ‐5D improved from 18 (13–24) and 0·73 (0·69–0·80) at baseline to 2 (0–7) and 0·85 (0·69–1·00) at 6 months, respectively ( P < 0·001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female sex, multiple comorbidities, smoking and a higher DLQI or a lower EQ‐5D utility score at baseline predicted a lower likelihood of achieving a DLQI of 0/1 or improvement in the EQ‐5D. Compared with adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biological therapies in EQ‐5D improvement.

          Conclusions

          In routine clinical practice biological therapies produce marked improvement in HRQoL, which is influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biological therapy for patients related to improvements in HRQoL.

          Abstract

          What's already known about this topic?

          • Evidence of the comparative effectiveness of biological therapies for psoriasis on health‐related quality of life (HRQoL) in routine clinical practice is limited.

          • Earlier observational studies were either cross‐sectional, thereby limiting the ability to compare changes in HRQoL, or cohort studies that have not taken into account important clinical factors that could influence treatment response, such as alterations in dosing regimens of biological therapies and the concomitant use of conventional systemic treatments for psoriasis.

          What does this study add?

          • This large prospective cohort study found that in routine clinical practice, the use of biological therapies for psoriasis was associated with marked improvements in HRQoL over 12 months.

          • These improvements were influenced by the choice of biological therapy, baseline impairment in HRQoL, lifestyle characteristics and comorbidities.

          • Compared with adalimumab, patients receiving etanercept were less likely to achieve a DLQI of 0/1, but there was no significant difference between ustekinumab and adalimumab in the proportion of patients achieving a DLQI of 0/1.

          • There was no significant difference between the three biological therapies in level of improvement in the EQ‐5D.

          Linked Comment: Finlay. Br J Dermatol 2017; 177:1164–1165 .

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          Most cited references51

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          Translating the science of quality of life into practice: What do dermatology life quality index scores mean?

          This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.
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            Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis: CLEAR, a randomized controlled trial.

            Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has shown superior efficacy to etanercept with similar safety in moderate to severe plaque psoriasis (FIXTURE study).
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              Determining the Minimal Clinically Important Difference and Responsiveness of the Dermatology Life Quality Index (DLQI): Further Data

              Aims: To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. Methods: A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. Results: 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a ‘small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. Conclusions: Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4.
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                Author and article information

                Contributors
                christopher.griffiths@manchester.ac.uk
                Journal
                Br J Dermatol
                Br. J. Dermatol
                10.1111/(ISSN)1365-2133
                BJD
                The British Journal of Dermatology
                John Wiley and Sons Inc. (Hoboken )
                0007-0963
                1365-2133
                19 October 2017
                November 2017
                : 177
                : 5 ( doiID: 10.1111/bjd.2017.177.issue-5 )
                : 1410-1421
                Affiliations
                [ 1 ] Centre for Pharmacoepidemiology and Drug Safety Division of Pharmacy and Optometry School of Health Sciences Faculty of Biology, Medicine and Health The University of Manchester Manchester U.K
                [ 2 ] Dermatology Centre Salford Royal NHS Foundation Trust The University of Manchester Manchester Academic Health Science Centre Manchester U.K
                [ 3 ] Division of Musculoskeletal and Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health The University of Manchester Manchester U.K
                [ 4 ] NIHR Manchester Biomedical Research Centre Faculty of Biology, Medicine and Health The University of Manchester Manchester U.K
                [ 5 ] Arthritis Research U.K. Centre for Epidemiology Division of Musculoskeletal and Dermatological Sciences Faculty of Biology, Medicine and Health The University of Manchester Manchester U.K
                [ 6 ] St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
                [ 7 ] Institute of Cellular Medicine, Medical School Faculty of Medical Sciences Newcastle University Newcastle upon Tyne U.K
                [ 8 ] NIHR Newcastle Biomedical Research Centre Faculty of Medical Sciences Newcastle University Newcastle upon Tyne U.K
                [ 9 ] Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne U.K
                Author notes
                [*] [* ] Correspondence

                Christopher E.M. Griffiths.

                E‐mail: christopher.griffiths@ 123456manchester.ac.uk

                Author information
                http://orcid.org/0000-0002-8030-1908
                Article
                BJD15531
                10.1111/bjd.15531
                6487951
                28369707
                aa665087-3d0b-4cd2-b526-9c25728f95e7
                © 2018 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 March 2017
                Page count
                Figures: 2, Tables: 5, Pages: 12, Words: 10338
                Funding
                Funded by: British Association of Dermatologists (BAD)
                Funded by: Medical Research Council
                Award ID: MR/L011808/1
                Funded by: NIHR‐Newcastle Biomedical Research Centre
                Categories
                General Dermatology
                Original Articles
                General Dermatology
                Custom metadata
                2.0
                bjd15531
                November 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:29.04.2019

                Dermatology
                Dermatology

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