Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.79.4.1450 |
Resumo: | Introduction: Methotrexate has been used in the systemic treatment of psoriasis since 1950 and remains a first-line drug. It is important to assess the factors that influence its discontinuation. The aim of the authors was to identify determinants of drug survival of metho- trexate in patients with psoriasis. Methods: A retrospective analysis was performed concerning patients who started psoriasis treatment with methotrexate between January 2010 and January 2020 and were included in the national registry DERMA.PT by the Centro Hospitalar Universitário São João. Results: A total of 146 patients with psoriasis treated with methotrexate alone or in combination with phototherapy were identified. Most were male (55%), with a mean age of 51±13 years and 65% had psoriasis for more than 10 years. Psoriasis vulgaris (49%) and psoriatic arthritis (47%) were the most common forms of psoriasis, with a mean initial PASI of 10.7±5.6. The majority of patients were methotrexate-naïve. In total, 66 (45%) patients discontinued treatment, with a mean survival time of 18.0±15.5 months. The most common reasons for discontinuation were ineffectiveness (32%), poor compliance (18%) and gastrointestinal intolerance (11%). Previous treatment with cyclosporine and the presence of psoriatic arthritis had both statistically significant associations with the discontinuation of methotrexate. In most cases, a switch to anti-TNFα monoclonal antibody was performed. Discussion: In recent years, retrospective studies have been published focusing on the drug survival of methotrexate in psoriasis, ranging from 12 to 21 months. The main reasons for discontinuation were ineffectiveness and adverse effects, namely gastrointestinal. Our study is in line with what has been described but stands out for the high percentage of patients who maintained treatment. The tremendous evolution in the treatment of psoriasis over the 10-year period of the study greatly influenced the results. The main limitation of this analysis results from its re- trospective nature. Conclusion: The results are in agreement with the published survival characteristics of methotrexate and reinforce its importance and role of this drug in the treatment of this disease. |
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Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT RegistryDeterminantes do Tempo de Sobrevivência do Metotrexato na Psoríase: Análise Retrospetiva de 10 Anos do Registo DERMA.PTMethotrexate/therapeutic usePortugalPsoriasis/therapyRegistriesPortugalMetotrexato/uso terapêuticoPsoríase/tratamentoRegistosIntroduction: Methotrexate has been used in the systemic treatment of psoriasis since 1950 and remains a first-line drug. It is important to assess the factors that influence its discontinuation. The aim of the authors was to identify determinants of drug survival of metho- trexate in patients with psoriasis. Methods: A retrospective analysis was performed concerning patients who started psoriasis treatment with methotrexate between January 2010 and January 2020 and were included in the national registry DERMA.PT by the Centro Hospitalar Universitário São João. Results: A total of 146 patients with psoriasis treated with methotrexate alone or in combination with phototherapy were identified. Most were male (55%), with a mean age of 51±13 years and 65% had psoriasis for more than 10 years. Psoriasis vulgaris (49%) and psoriatic arthritis (47%) were the most common forms of psoriasis, with a mean initial PASI of 10.7±5.6. The majority of patients were methotrexate-naïve. In total, 66 (45%) patients discontinued treatment, with a mean survival time of 18.0±15.5 months. The most common reasons for discontinuation were ineffectiveness (32%), poor compliance (18%) and gastrointestinal intolerance (11%). Previous treatment with cyclosporine and the presence of psoriatic arthritis had both statistically significant associations with the discontinuation of methotrexate. In most cases, a switch to anti-TNFα monoclonal antibody was performed. Discussion: In recent years, retrospective studies have been published focusing on the drug survival of methotrexate in psoriasis, ranging from 12 to 21 months. The main reasons for discontinuation were ineffectiveness and adverse effects, namely gastrointestinal. Our study is in line with what has been described but stands out for the high percentage of patients who maintained treatment. The tremendous evolution in the treatment of psoriasis over the 10-year period of the study greatly influenced the results. The main limitation of this analysis results from its re- trospective nature. Conclusion: The results are in agreement with the published survival characteristics of methotrexate and reinforce its importance and role of this drug in the treatment of this disease.Introdução: O metotrexato é utilizado no tratamento sistémico da psoríase desde 1950, continuando a ser um fármaco de primeira linha. É importante avaliar os fatores que influenciam a sua descontinuação. O objetivo dos autores foi identificar determinantes do tempo de so- brevivência do metotrexato em doentes com psoríase. Métodos: Foi realizada uma análise retrospetiva dos doentes incluídos no registo nacional DERMA.PT pelo Centro Hospitalar Universitário São João e que iniciaram tratamento para a psoríase com metotrexato entre janeiro de 2010 e janeiro de 2020. Resultados: Foram identificados 146 doentes com psoríase tratados com metotrexato em monoterapia ou em associação com fototerapia. A maioria era do sexo masculino (55%), com idade média de 51±13 anos e com psoríase há mais de 10 anos. A psoríase vulgar (49%) e a psoríase artropática (47%) foram as formas mais comuns de psoríase, com um PASI inicial médio de 10,7±5,6. A maioria dos doentes era naïve para o tratamento com metotrexato. No total, 66 (45%) doentes descontinuaram o tratamento, com um tempo médio de sobrevivência do fármaco de 18,0±15,5 meses. As razões mais comuns de descontinuação foram ineficácia (32%), má adesão terapêutica (18%) e intolerância gastrointestinal (11%). O tratamento prévio com ciclosporina e a presença de artrite psoriática associaram-se ambos à descontinuação do metotrexato (estatisticamente significativo). Na maioria dos casos, foi realizado switch para anticorpo monoclonal anti-TNFα. Discussão: Nos últimos anos, foram publicados estudos retrospetivos com enfoque no tempo de sobrevivência do metotrexato na psoríase, que revelaram um tempo médio entre 12 a 21 meses. As principais razões de descontinuação foram a ineficácia e os efeitos adversos, nomeadamente gastrointestinais. O nosso estudo está em linha com o descrito mas destaca-se pela elevada percentagem de doentes que mantiveram o tratamento. A tremenda evolução no tratamento da psoríase ao longo dos 10 anos do estudo influenciou grandemente os resultados. A principal limitação desta análise resulta do facto de ser um estudo retrospetivo. Conclusão: Os resultados estão de acordo com as caraterísticas de sobrevivência do metotrexato publicadas e reforçam a sua importância e o seu papel no tratamento desta doença. Sociedade Portuguesa de Dermatologia e Venereologia2021-12-27T00:00:00Zjournal articleinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.79.4.1450oai:ojs.revista.spdv.com.pt:article/1450Journal of the Portuguese Society of Dermatology and Venereology; Vol 79 No 4 (2021): October - December; 329-337Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 79 n. 4 (2021): Outubro - Dezembro; 329-3372182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/1450https://doi.org/10.29021/spdv.79.4.1450https://revista.spdv.com.pt/index.php/spdv/article/view/1450/934Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereologyhttps://creativecommons.org/licenses/by-nc/4.0info:eu-repo/semantics/openAccessGomes, NunoDias, CamilaAzevedo, FilomenaMagina, Sofia2022-10-06T12:35:21Zoai:ojs.revista.spdv.com.pt:article/1450Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:11:22.170636Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry Determinantes do Tempo de Sobrevivência do Metotrexato na Psoríase: Análise Retrospetiva de 10 Anos do Registo DERMA.PT |
title |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
spellingShingle |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry Gomes, Nuno Methotrexate/therapeutic use Portugal Psoriasis/therapy Registries Portugal Metotrexato/uso terapêutico Psoríase/tratamento Registos |
title_short |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
title_full |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
title_fullStr |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
title_full_unstemmed |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
title_sort |
Determinants for Drug Survival of Methotrexate in Patients with Psoriasis: 10-Years Retrospective Analysis of DERMA.PT Registry |
author |
Gomes, Nuno |
author_facet |
Gomes, Nuno Dias, Camila Azevedo, Filomena Magina, Sofia |
author_role |
author |
author2 |
Dias, Camila Azevedo, Filomena Magina, Sofia |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Gomes, Nuno Dias, Camila Azevedo, Filomena Magina, Sofia |
dc.subject.por.fl_str_mv |
Methotrexate/therapeutic use Portugal Psoriasis/therapy Registries Portugal Metotrexato/uso terapêutico Psoríase/tratamento Registos |
topic |
Methotrexate/therapeutic use Portugal Psoriasis/therapy Registries Portugal Metotrexato/uso terapêutico Psoríase/tratamento Registos |
description |
Introduction: Methotrexate has been used in the systemic treatment of psoriasis since 1950 and remains a first-line drug. It is important to assess the factors that influence its discontinuation. The aim of the authors was to identify determinants of drug survival of metho- trexate in patients with psoriasis. Methods: A retrospective analysis was performed concerning patients who started psoriasis treatment with methotrexate between January 2010 and January 2020 and were included in the national registry DERMA.PT by the Centro Hospitalar Universitário São João. Results: A total of 146 patients with psoriasis treated with methotrexate alone or in combination with phototherapy were identified. Most were male (55%), with a mean age of 51±13 years and 65% had psoriasis for more than 10 years. Psoriasis vulgaris (49%) and psoriatic arthritis (47%) were the most common forms of psoriasis, with a mean initial PASI of 10.7±5.6. The majority of patients were methotrexate-naïve. In total, 66 (45%) patients discontinued treatment, with a mean survival time of 18.0±15.5 months. The most common reasons for discontinuation were ineffectiveness (32%), poor compliance (18%) and gastrointestinal intolerance (11%). Previous treatment with cyclosporine and the presence of psoriatic arthritis had both statistically significant associations with the discontinuation of methotrexate. In most cases, a switch to anti-TNFα monoclonal antibody was performed. Discussion: In recent years, retrospective studies have been published focusing on the drug survival of methotrexate in psoriasis, ranging from 12 to 21 months. The main reasons for discontinuation were ineffectiveness and adverse effects, namely gastrointestinal. Our study is in line with what has been described but stands out for the high percentage of patients who maintained treatment. The tremendous evolution in the treatment of psoriasis over the 10-year period of the study greatly influenced the results. The main limitation of this analysis results from its re- trospective nature. Conclusion: The results are in agreement with the published survival characteristics of methotrexate and reinforce its importance and role of this drug in the treatment of this disease. |
publishDate |
2021 |
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2021-12-27T00:00:00Z |
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journal article info:eu-repo/semantics/article |
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info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
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https://doi.org/10.29021/spdv.79.4.1450 oai:ojs.revista.spdv.com.pt:article/1450 |
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https://doi.org/10.29021/spdv.79.4.1450 |
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oai:ojs.revista.spdv.com.pt:article/1450 |
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https://revista.spdv.com.pt/index.php/spdv/article/view/1450 https://doi.org/10.29021/spdv.79.4.1450 https://revista.spdv.com.pt/index.php/spdv/article/view/1450/934 |
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Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereology https://creativecommons.org/licenses/by-nc/4.0 info:eu-repo/semantics/openAccess |
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Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereology https://creativecommons.org/licenses/by-nc/4.0 |
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openAccess |
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Sociedade Portuguesa de Dermatologia e Venereologia |
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Sociedade Portuguesa de Dermatologia e Venereologia |
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Journal of the Portuguese Society of Dermatology and Venereology; Vol 79 No 4 (2021): October - December; 329-337 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 79 n. 4 (2021): Outubro - Dezembro; 329-337 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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