Identification of factors that may influence the selection of first-line biologic therapy for people with psoriasis: a prospective, multi-centre cohort study

Summary

Background

The Psoriasis Stratification to Optimise Relevant Therapy (PSORT) consortium has a collective aim to develop a prescribing algorithm to help stratify eligible psoriasis patients to the most appropriate biologic treatment. To facilitate the adoption of a stratified approach, it is necessary to first understand the factors driving the choice of first-line biologic therapy.

Objectives

To identify and quantify factors which influence the selection of the first-line biologic therapy for people with psoriasis.

Methods

Multinomial logistic regression was used to determine the factors which influenced the probability of treatment selection, using data from the British Association of Dermatologists Biologic Interventions Register (BADBIR) from January 2012 to December 2015. Sensitivity analyses were performed to assess the robustness of the findings to key assumptions.

Results

The main analysis was based on a dataset comprising 3,040 people with psoriasis. The identified factors affecting first-line biologic selection within the available therapies were: presence of psoriatic arthritis; patient weight; employment status; country of registration; and baseline disease severity. Importantly, the analysis showed a general shift in prescribing behaviour over time. These results were robust to sensitivity analysis.

Conclusions

This study offers important insights into the factors influencing current prescribing practice for first-line biologic therapies for people with psoriasis. It provides baseline data to inform the evaluation of future potential changes that may impact prescribing behaviour such as stratified medicine.

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