BACKGROUND: Evidence of the comparative effectiveness of biologic 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 psoriasis patients, and to identify potential predictors for improved HRQoL.
METHOD: 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 EQ5D utility score.
RESULTS: In total, 2152 psoriasis patients (adalimumab (n = 1239), etanercept (n = 517) and ustekinumab (n = 396); 81% were biologic-naïve) were included. 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 < 0.0001). Similar improvements were achieved at 12 months. At 12 months, multivariable regression modelling showed that female gender, multiple comorbidities, smoking, and a higher DLQI or a lower EQ-5D utility score at baseline predicted lower likelihood of achieving a DLQI of 0/1 or improvement in EQ-5D. Compared against adalimumab, patients receiving etanercept, but not ustekinumab, were less likely to achieve a DLQI of 0/1. There was no significant difference between the biologics in EQ-5D improvement.
CONCLUSION: In routine clinical practice, biologics produce marked improvement in HRQoL which is influenced by the choice of biologic, baseline impairment in HRQoL, lifestyle characteristics and comorbidities. These findings should help inform selection of optimal biologic therapy for patients related to improvements in HRQoL. This article is protected by copyright. All rights reserved.