Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis

作者：Stull D E^*; Griffiths C E M; Gilloteau I; Zhao Y; Guana A; Finlay A Y; Sherif B; Houghton K; Puig L

来源：British Journal of Dermatology, 2018, 178(6): 1297-1307.

DOI：10.1111/bjd.16366

Background The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self-esteem and reduced work productivity.
Objectives To examine direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity and activity impairment based on psoriasis severity and symptoms.
Methods Analyses were based on data from the CLEAR study. Structural equation modelling examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area and Severity Index (PASI) severity and symptoms (pain, itching and scaling) as potential mediators. Analyses were conducted primarily for patients achieving a PASI 90 response (90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75 and 100.
Results Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by the PASI 90 response and by improvements in itching, pain, and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching and scaling were correlated (r = 0.51-0.68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab.
Conclusions The results underscore the important role of both PASI response and reduction in symptoms on improvements in health-related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab.
What's already known about this topic?
There are only weak to moderate correlations between Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores.
Factors other than area and severity may play a role in patients' evaluations of their health-related quality of life (HRQoL).
Patients perceive pain, itching and scaling to be the most troubling aspects of their psoriasis.
What does this study add?
Both PASI response and improved psoriasis-related symptoms of pain, itching and scaling have an important role for improvements in HRQoL and work and daily activity.
Improvements in PASI, patient-reported symptoms, HRQoL, and work and daily activity were greater for those patients on secukinumab vs. ustekinumab.

• 出版日期2018-6