| Abstract [eng] |
Psoriasis is a chronic, immune-mediated systemic inflammatory disease affecting more than 125 million people worldwide and approximately 76,000 patients in Lithuania (prevalence ~2%). Biological agents targeting tumour necrosis factor (TNF-α) and interleukins 12/23, 17, and 23 represent one of the principal systemic treatment options for moderate-to-severe psoriasis. Despite extensive international clinical trial and registry data, long-term real-world evidence from Lithuania and the broader Eastern European region remains scarce. This limits the extrapolation of international findings to local clinical practice, where reimbursement conditions, prescribing criteria, and patient population characteristics may differ substantially. Aim. To evaluate the effectiveness, drug survival, and treatment-switching patterns of biological therapy in patients with moderate-to-severe psoriasis. Methods. A retrospective medical record review was conducted in 210 patients treated with biological therapy between 2018 and 2023 at Vilnius University Hospital Santaros Klinikos, Centre of Dermatovenereology. Demographic data, PASI and DLQI dynamics, adverse events, treatment-switching reasons, and drug survival were analysed. Results. Of the 210 patients included in the study, 60.0% (n = 126) were male. The mean age was 48.3 ± 13.6 years in men and 48.4 ± 13.6 years in women. The mean baseline PASI was 15.0 ± 8.1 and decreased to 3.3 ± 4.7, 2.7 ± 4.0, and 2.8 ± 3.3 at 1, 3, and 5 years, respectively. A PASI 90 response (≥90% reduction from baseline) was achieved within a mean of 26.1 weeks with adalimumab, risankizumab, and ustekinumab, and within 39.1 weeks with guselkumab. The highest proportion of patients achieving a PASI 100 response (≥100% reduction from baseline) at least once during follow-up was observed with adalimumab (38.1%), risankizumab (37.5%), and guselkumab (36.0%). The unadjusted Cox proportional hazards model showed that etanercept was associated with a statistically significantly higher hazard of discontinuation compared with ustekinumab (HR 2.55; 95% CI 1.17–5.52; p = 0.018), whereas infliximab and adalimumab were associated with a lower hazard of discontinuation than etanercept. The highest 5-year drug survival was observed with risankizumab (95.8%) and guselkumab (88.0%), and the lowest with etanercept (10.0%). Of the 210 patients, 154 continued treatment with the initially prescribed biologic; the primary reason for switching was insufficient efficacy (93.8%). Within 12 months, all studied biologic agents produced statistically significant improvements in patients' quality of life, with the lowest DLQI score at 1 year observed with risankizumab (2.7 ± 3.9). Conclusions. Biologic therapy was associated with sustained improvement in PASI and DLQI across all treatment classes over five years, with significant between-drug differences in treatment trajectories identified after adjustment for baseline patient characteristics. Etanercept demonstrated the lowest long-term drug survival, while switching due to insufficient efficacy frequently restored clinically meaningful responses in subsequent lines. These findings provide real-world evidence of biologic efficacy and drug survival from Lithuania, contributing data from a Baltic region setting currently underrepresented in the international literature. |
