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Drug survival reflects a drug’s effectiveness, safety, and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (British Association of Dermatologists Biologic Interventions Register (BADBIR)). The survival rates of the first course of biologics for 3,523 biologic-naive patients with chronic plaque psoriasis were compared using survival analysis techniques and predictors of discontinuation analyzed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1,879), etanercept (n=1,098), infliximab (n=96), and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed that female gender (hazard ratio (HR) 1.22; 95% confidence interval (CI): 1.09–1.37), being a current smoker (HR 1.19; 95% CI: 1.03–1.38), and a higher baseline dermatology life quality index (HR 1.01; 95% CI: 1.00–1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI: 0.71–0.96) was a predictor for drug survival. As compared with adalimumab, patients on etanercept (HR 1.63; 95% CI: 1.45–1.84) or infliximab (HR 1.56; 95% CI: 1.16–2.09) were more likely to discontinue therapy, whereas patients on ustekinumab were more likely to persist (HR 0.48; 95% CI: 0.37–0.62). After accounting for relevant covariates, ustekinumab had the highest first-course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.

Purpose To derive a mapping algorithm to predict SF-6D utility scores from the non-preference-based LupusQoL and test the performance of the developed algorithm on a separate independent validation data set. Method LupusQoL and SF-6D data were collected from 320 patients with systemic lupus erythematosus (SLE) attending routine rheumatology outpatient appointments at seven centres in the UK. Ordinary least squares (OLS) regression was used to estimate models of increasing complexity in order to predict individuals' SF-6D utility scores from their responses to the LupusQoL questionnaire. Model performance was judged on predictive ability through the size and pattern of prediction errors generated. The performance of the selected model was externally validated on an independent data set containing 113 female SLE patients who had again completed both the LupusQoL and SF-36 questionnaires. Results Four of the eight LupusQoL domains (physical health, pain, emotional health, and fatigue) were selected as dependent variables in the final model. Overall model fit was good, with R² 0.7219, MAE 0.0557, and RMSE 0.0706 when applied to the estimation data set, and R2 0.7431, MAE 0.0528, and RMSE 0.0663 when applied to the validation sample. Conclusion This study provides a method by which health state utility values can be estimated from patient responses to the non-preference-based LupusQoL, generalisable beyond the data set upon which it was estimated. Despite concerns over the use of OLS to develop mapping algorithms, we find this method to be suitable in this case due to the normality of the SF-6D data.

Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real‐world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first‐line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored. Data were collected from a UK prospective multicenter observational cohort (491 patients on ustekinumab monotherapy, drug levels, and anti‐drug antibody measurements on 797 serum samples, 1,590 measurements of Psoriasis Area Severity Index (PASI)). Ustekinumab PKs were described with a linear one‐compartment model. A maximum effect (Emax) model inhibited progression of psoriatic skin lesions in the turnover PD mechanism describing PASI evolution while on treatment. A mixture model on half‐maximal effective concentration identified a potential nonresponder group, with simulations suggesting that, in future, the model could be incorporated into a Bayesian therapeutic drug monitoring “dashboard” to individualize dosing and improve treatment outcomes.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In the evaluation of patients with SLE it is important to measure not only disease activity and damage but also the impact of the disease on their health related quality of life (HRQoL). Disease-specific HRQoL measures are considered to be more relevant and sensitive to change. As none were currently available, this present work was conducted to develop and validate a patient-derived measure, the Lupus Quality of Life (LupusQoL) Questionnaire and to use it to describe HRQoL in a group of patients. Several stages of development led to the validation of the questionnaire. The generation of items was informed by: existing HRQoL literature; other FIRQoL measures; consultation with the rheumatology multi-disciplinary team; and patient interviews (n=30). From this, a measure comprising 67 items was generated. Twenty patients completed this initial version providing critical feedback regarding face validity and structure, content of the items and response scales, leading to further revision of the LupusQoL. This revised version of the LupusQoL (63 items) was completed by 322 patients. Principal components analysis and Cronbach alpha coefficients highlighted eight domains. The LupusQoL was further revised (42 items) based on factor analysis, clinical decision and patient feedback. Principal components analysis was performed on the data from the second version of the LupusQoL, completed by 213 patients. This confirmed the factor structure of the LupusQoL. The final measure contains 34 items comprising eight domains: physical functioning, pain, emotional functioning, fatigue, body image, intimate relationships, planning and burden to others. Cronbach alpha coefficients (all values > 0.8) and item to domain correlations showed good internal consistency of the subscales. Test-retest reliability and concurrent validity have also shown that the instrument is robust. For all domains except fatigue those with no current activity and/or only mild activity in any systems reported a better HRQoL than (a) those with moderate activity in any systems and (b) those with severe active disease in any systems (p'c0.05). Patients with no damage reported a better HRQoL than those with damage for physical health, pain, planning, intimate relationships and burden to others (p < O.O5). The LupusQoL is a valid and reliable lupus-specific HRQoL measure for adults with SLE.