HRQoL in Plaque Psoriasis Improves With Biologics, Review Says

Five biologics used in the treatment of adult patients with plaque psoriasis have been found to improve health-related quality of life.

A systematic literature review of studies on 5 biologics used in the treatment of adult patients with plaque psoriasis found they provided improved health-related quality of life (HRQoL).

The study, published in PLoS One, investigated the effect of infliximab (Remicade), adalimumab (Humira), ixekizumab (Taltz), secukinumab (Cosentyx), and tofacitinib (Xeljanz) on a commonly used scale called the Dermatology Life Quality Index (DLQI).

The authors found that the mean DLQI scores ranged from 6.83 to 17.8 with the overall DLQI score of 12.12 (95% CI, 11.24-13.06). Furthermore, the patients with lower quality of life before treatment saw better results. According to the European consensus, DLQI ≥ 10 qualifies for systemic treatment.

Psoriasis affects approximately 2% of the world population, with the lowest incidence in Asian and some African populations, and the highest reaching up to 11% in Caucasian and Scandinavian populations. Plaque psoriasis is by far the most common, representing 80% of all diagnosed cases.

Infliximab and adalimumab are tumor necrosis factor inhibitors. Secukinumab and ixekizumab block interleukin 17. Tofacitinib is a small synthetic molecule used in psoriasis treatment.

The review encompassed 43 studies and a total of 25,898 individuals. A statistical analysis showed considerable heterogeneity of the study results. Only 17 papers, however, had sufficient data for analyzing the effect of the selected biological agents and tofacitinib. The remaining 26 studies were retained in the analysis solely for investigating the differences in the DLQI scoring for various races.

However, even when including the additional studies, the authors said, a lack of information regarding geographic and climactic conditions hindered analysis. From the data available, they found the race of the studied subjects gave no indication that it had an impact on the improvement of health-related quality of life on those treated with any of the five therapies.

Results for secukinumab indicated it was the most effective in improving quality of life, the authors wrote. However, there were only 2 studies, limiting the ability to make any steadfast conclusions.

There were 7 studies found on infliximab. DLQI after treatment ranged from 2.2 to 4.3. Duration of therapy was 10 to 42 weeks.

There were 4 studies for adalimumab and ixekizumab. For adalimumab, the range was of DLQI after treatment was 2.4 to 5.28, with data collected at 12, 16, or 24 weeks. For ixekizumab, the range was 2.5 to 4.7, with data collected at 12 or 24 weeks.

For secukinumab, the 2 studies reported a DLQI of 2.2 and 2.8, with data collected at 24 and 52 weeks. For tofacitinib, there were 4 studies, reporting DLQI from 2.6 to 5.1; therapy duration was 12 and 24 weeks. Generally, each of the agents performed considerably better in comparison to placebo.

DLQI is a 10-item questionnaire with 6 domains of daily life: symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment.

Reference

Karpińska-Mirecka A, Bartosińska J, Krasowska D. The effects of selected biologics and a small molecule on Health-Related Quality of Life in adult plaque psoriasis patients: A systematic review and meta-analysis. PLoS One. 2020;15(12). Published online December 3, 2020. doi:10.1371/journal.pone.0241604