Efficacy of psoralen plus ultraviolet A therapy vs. biologics in moderate to severe chronic plaque psoriasis: retrospective data analysis of a patient registry.

Abstract

BACKGROUND:

Few studies have directly compared the clinical efficacy of psoralen plus ultraviolet A (PUVA) vs. biologics in the treatment of psoriasis.

OBJECTIVES:

To compare the clinical efficacy of PUVA and biologic therapies for psoriasis under daily life conditions.

METHODS:

Data from a psoriasis registry (http://www.psoriasis-therapieregister.at) of 172 adult patients with moderate to severe chronic plaque psoriasis treated between 2003 and 2010 were analysed retrospectively. These patients had received oral PUVA [118 treatment courses including 5-methoxypsoralen (5-MOP; n = 32) and 8-methoxypsoralen (8-MOP; n = 86)] and/or biologic agents [130 treatment courses including adalimumab (n = 18), alefacept (n = 32), efalizumab (n = 17), etanercept (n = 38), infliximab (n = 7) and ustekinumab (n = 18)]. Treatment responses were analysed in terms of Psoriasis Area and Severity Index (PASI) improvement, including complete remission (CR) and reduction of PASI by at least 90% (PASI 90) or 75% (PASI 75), at treatment completion for PUVA (median time 10·3 and 9·2 weeks, for 8-MOP and 5-MOP, respectively) and at week 12 for biologics.

RESULTS:

Intention-to-treat-as observed CR, PASI 90 and PASI 75 rate was 22%, 69% and 86% for PUVA compared with 6%, 22% and 56% for adalimumab (P = 0·0034 by adapted Wilcoxon test), 3%, 3% and 25% for alefacept (P = 0·000000002), 6%, 6% and 59% for efalizumab (P = 0·000053), 6%, 29% and 39% for etanercept (P = 0·0000086), 29%, 71% and 100% for infliximab (P = 0·36) and 6%, 39% and 67% for ustekinumab (P = 0·028). When applying a more conservative post-hoc modified worst-case scenario analysis, with CR of 15%, PASI 90 of 58% and PASI 75 of 69%, PUVA was superior only to alefacept (P = 0·000013), efalizumab (P = 0·015) and etanercept (P = 0·0037). There were no statistically significant differences in PASI reduction rates between PUVA and infliximab.

CONCLUSIONS:

Retrospective analysis of registry data revealed that the primary efficacy of PUVA was superior to that of certain biologics. Prospective head-to-head studies of PUVA and biologics are warranted to confirm these observations.

• Authors: M Inzinger, B Heschl, W Weger, A Hofer, F J Legat, A Gruber-Wackernagel, H Tilz, W Salmhofer, F Quehenberger, P Wolf
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 165 Issue 3 Pg. 640-5 (Sep 2011) ISSN: 1365-2133 [Electronic] England
• PMID: 21564068 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

Chemical References

• Antibodies, Monoclonal
• Biological Products
• Photosensitizing Agents
• 5-Methoxypsoralen
• Methoxsalen

Topics

• 5-Methoxypsoralen
• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Biological Products (therapeutic use)
• Chronic Disease
• Combined Modality Therapy (methods)
• Female
• Humans
• Male
• Methoxsalen (analogs & derivatives, therapeutic use)
• Middle Aged
• PUVA Therapy (methods)
• Photosensitizing Agents (therapeutic use)
• Psoriasis (drug therapy)
• Registries
• Retrospective Studies
• Treatment Outcome