PMID- 37226927
OWN - NLM
STAT- MEDLINE
DCOM- 20230830
LR  - 20230830
IS  - 1365-2133 (Electronic)
IS  - 0007-0963 (Linking)
VI  - 189
IP  - 3
DP  - 2023 Aug 24
TI  - Effectiveness and survival of methotrexate versus adalimumab in patients with 
      moderate-to-severe psoriasis: a cohort study from the British Association of 
      Dermatologists Biologics and Immunomodulators Register (BADBIR).
PG  - 271-278
LID - 10.1093/bjd/ljad179 [doi]
AB  - BACKGROUND: Most information on the comparative effectiveness and survival of 
      methotrexate (MTX) and adalimumab (ADA) in the treatment of psoriasis is from 
      randomized control trials and may not translate to the everyday clinical setting. 
      OBJECTIVES: To determine the real-world effectiveness and survival of MTX and ADA 
      in patients with moderate-to-severe psoriasis registered in the British 
      Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). 
      METHODS: Eligible patients were registered in BADBIR, >/= 16 years of age and 
      receiving a first course of MTX or ADA between September 2007 and December 2021, 
      with >/= 6 months of follow-up. Effectiveness was defined as achieving an absolute 
      Psoriasis Area and Severity Index (PASI) </= 2 reported >/= 13 weeks after the 
      treatment start date until the stop date. The average treatment effect (ATE) was 
      estimated using inverse probability of treatment weighting with propensity score, 
      including baseline covariates. ATE results were presented as risk ratios (RR). A 
      flexible parametric model was used to estimate adjusted standardized average 
      survival, defined as treatment discontinuation associated with ineffectiveness or 
      the occurrence of adverse events (AEs) at 6, 12 and 24 months. Restricted mean 
      survival time (RMST) at 2 years of treatment exposure was calculated. RESULTS: In 
      total, 6575 patients (median age 44 years; 44% female) were analysed; 2659 
      (40.4%) were prescribed MTX and 3916 (59.5%) ADA. The proportion of patients 
      achieving PASI </= 2 was higher in the ADA cohort (77.4%) than in the MTX cohort 
      (37.4%). ADA was more effective than MTX [RR 2.20, 95% confidence interval (CI) 
      1.98-2.45]. Overall survival associated with ineffectiveness or AEs was lower in 
      the MTX cohort than in the ADA cohort at 6 months [survival estimate 69.7 (95% CI 
      67.9-71.5) vs. 90.6 (95% CI 89.8-91.4)], 1 year [survival estimate 52.5 (95% CI 
      50.4-54.8) vs. 80.6 (95% CI 79.5-81.8)] and 2 years [survival estimate 34.8 (95% 
      CI 32.5-37.2) vs. 68.6 (95% CI 67.2-70.0)]. The difference in RMST (years) 
      overall, or when stratified by ineffectiveness and AEs, was 0.53 (95% CI 
      0.49-0.58), 0.37 (95% CI 0.33-0.42) and 0.29 (95% CI 0.25-0.33), respectively. 
      CONCLUSIONS: Patients on ADA were twice as likely to be clear or nearly clear of 
      psoriasis and were less likely to discontinue their medication than patients on 
      MTX. Findings from this real-world cohort provide important information to aid 
      clinicians managing patients with psoriasis.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of British 
      Association of Dermatologists.
FAU - Alabas, Oras A
AU  - Alabas OA
AD  - Centre for Dermatology Research, University of Manchester, NIHR Manchester 
      Biomedical Research Centre, Manchester, UK.
FAU - Mason, Kayleigh J
AU  - Mason KJ
AUID- ORCID: 0000-0002-5419-0669
AD  - Primary Care Centre Versus Arthritis, School of Medicine, Keele University, 
      Keele, UK.
FAU - Yiu, Zenas Z N
AU  - Yiu ZZN
AUID- ORCID: 0000-0002-1831-074X
AD  - Centre for Dermatology Research, University of Manchester, NIHR Manchester 
      Biomedical Research Centre, Manchester, UK.
FAU - Warren, Richard B
AU  - Warren RB
AUID- ORCID: 0000-0002-2918-6481
AD  - Centre for Dermatology Research, University of Manchester, NIHR Manchester 
      Biomedical Research Centre, Manchester, UK.
FAU - Lunt, Mark
AU  - Lunt M
AD  - Centre for Dermatology Research, University of Manchester, NIHR Manchester 
      Biomedical Research Centre, Manchester, UK.
FAU - Smith, Catherine H
AU  - Smith CH
AD  - St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and 
      King's College London, London, UK.
FAU - Grif fi ths, Christopher E M
AU  - Grif fi ths CEM
AD  - Centre for Dermatology Research, University of Manchester, NIHR Manchester 
      Biomedical Research Centre, Manchester, UK.
CN  - BADBIR Study Group
LA  - eng
GR  - British Association of Dermatologists Biologic Register Ltd (BADBRL)/
GR  - University of Manchester/
GR  - National Institute for Health and Care Research (NIHR)/
GR  - Newcastle's Biomedical Research Centres/
PT  - Clinical Trial
PT  - Journal Article
PL  - England
TA  - Br J Dermatol
JT  - The British journal of dermatology
JID - 0004041
RN  - FYS6T7F842 (Adalimumab)
RN  - 0 (Adjuvants, Immunologic)
RN  - 0 (Biological Factors)
RN  - 0 (Biological Products)
RN  - OP401G7OJC (Etanercept)
RN  - 0 (Immunologic Factors)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
CIN - Br J Dermatol. 2023 Jul 09;:. PMID: 37421659
CIN - Br J Dermatol. 2023 Aug 24;189(3):e64. PMID: 37620020
MH  - Adult
MH  - Female
MH  - Humans
MH  - Male
MH  - Adalimumab/adverse effects
MH  - Adjuvants, Immunologic/therapeutic use
MH  - Biological Factors/therapeutic use
MH  - *Biological Products/adverse effects
MH  - Cohort Studies
MH  - Dermatologists
MH  - Etanercept/therapeutic use
MH  - Immunologic Factors/therapeutic use
MH  - Methotrexate/adverse effects
MH  - *Psoriasis/drug therapy
MH  - Severity of Illness Index
MH  - Treatment Outcome
COIS- Conflicts of interest R.B.W. has acted as a consultant and/or speaker for and/or 
      received research grants from AbbVie, Amgen, Almirall, Celgene, Eli Lilly, 
      Pfizer, LEO Pharma, Novartis, Janssen Cilag, Medac, UCB Pharma and Xenoport. 
      C.H.S. reports grants from a Medical Research Council-funded stratified medicine 
      consortium with multiple industry partners, grants from an Innovative Medicines 
      Initiative (Horizon 2020)-funded European consortium with multiple industry 
      partners, and others from AbbVie, Novartis, Pfizer, Sanofi, Boehringer Ingelheim 
      and SOBI, outside the submitted work; she is also chair of UK guidelines on 
      biological therapy in psoriasis. C.E.M.G. has received honoraria and/or research 
      grants from AbbVie, Almirall, Amgen, Anaptysbio, Bristol-Myers Squibb, Celgene, 
      Galderma, LEO Pharma, Eli Lilly, GSK-Stiefel, Janssen Cilag, MSD, Novartis, 
      Pfizer, Sandoz and UCB Pharma. O.A.A., K.J.M., Z.Z.N.Y. and M.L. declare no 
      conflicts of interest.
FIR - Barker, Jonathan
IR  - Barker J
FIR - Morrison, Simon
IR  - Morrison S
FIR - Bewley, Anthony
IR  - Bewley A
FIR - Evans, Ian
IR  - Evans I
FIR - Griffiths, Christopher
IR  - Griffiths C
FIR - Ahmed, Shehnaz
IR  - Ahmed S
FIR - Kirby, Brian
IR  - Kirby B
FIR - Kleyn, Elise
IR  - Kleyn E
FIR - Laws, Philip
IR  - Laws P
FIR - Hampton, Philip
IR  - Hampton P
FIR - Alabas, Oras
IR  - Alabas O
FIR - McElhone, Kathleen
IR  - McElhone K
FIR - Yiu, Zenas
IR  - Yiu Z
FIR - Mackenzie, Teena
IR  - Mackenzie T
FIR - McPherson, Tess
IR  - McPherson T
FIR - Murphy, Ruth
IR  - Murphy R
FIR - Ormerod, Anthony
IR  - Ormerod A
FIR - Walton, Shernaz
IR  - Walton S
FIR - Reynolds, Nick
IR  - Reynolds N
FIR - Smith, Catherine
IR  - Smith C
FIR - Warren, Richard
IR  - Warren R
FIR - Weller, Richard
IR  - Weller R
FIR - Gupta, Girish
IR  - Gupta G
FIR - Zietemann, Vera
IR  - Zietemann V
EDAT- 2023/05/25 13:07
MHDA- 2023/08/28 06:41
CRDT- 2023/05/25 06:23
PHST- 2022/12/02 00:00 [received]
PHST- 2023/03/18 00:00 [revised]
PHST- 2023/05/22 00:00 [accepted]
PHST- 2023/08/28 06:41 [medline]
PHST- 2023/05/25 13:07 [pubmed]
PHST- 2023/05/25 06:23 [entrez]
AID - 7179435 [pii]
AID - 10.1093/bjd/ljad179 [doi]
PST - ppublish
SO  - Br J Dermatol. 2023 Aug 24;189(3):271-278. doi: 10.1093/bjd/ljad179.