Efficacy of PUVA therapy versus biologics in moderate to severe chronic plaque psoriasis: retrospective data analysis of a patient registry
Inzinger M, Heschl B, Weger W, Hofer A, Legat FJ, Gruber-Wackernagel A, Tilz H, Salmhofer W, Quehenberger F, Wolf P; British Journal of Dermatology (May 2011)
Source: Br J Dermatol
Background: Hardly any studies have directly compared the clinical efficacy of PUVA versus biologics in the treatment of psoriasis.
Objectives: To compare the clinical efficacy of PUVA and biologic therapies for psoriasis under daily life conditions.
Methods: Data from a psoriasis registry of 172 adult patients with moderate to severe chronic plaque psoriasis treated between 2003 and 2010 were analyzed retrospectively. These patients had received oral PUVA (118 treatment courses including 5-methoxypsoralen [5-MOP] [n=32]and 8-methoxypsoralen [8-MOP] [n=86]) and/or biologic agents (130 treatment courses including adalimumab [n=18], alefacept [n=32]; efalizumab [n=17]; etanercept [n=38]; infliximab [n=7]; and ustekinumab [n= 18]). Treatment responses were analyzed in terms of psoriasis-area-and-severity-index (PASI) improvement, including complete remission (CR), reduction of PASI by at least 90% (PASI90) or 75% (PASI75) at treatment completion for PUVA (median time, 10.3 and 9.2 weeks, for 8-MOP and 5-MOP, respectively) and at week 12 for biologics.
Results: Intention-to-treat-as-observed CR, PASI90, and PASI75 rate was 22, 69, and 86% for PUVA compared to 6, 22, and 56% for adalimumab (P=0.0034 by adapted Wilcoxon test); 3, 3, and 25% for alefacept (P=0.000000002); 6, 6, and 59% for efalizumab (P=0.000053), 6, 29 and 39% for etanercept (P=0.0000086); 29, 71, 100% for infliximab (P=0.36); and 6, 39, and 67% for ustekinumab (P=0.028). When applying a more conservative post-hoc modified worst-case scenario analysis, with CR of 15%, PASI90 of 58%, and PASI75 of 69%, PUVA was superior only to alefacept (P=0.000013), efalizumab (P=0.015), and etanercept (P=0.0037). There were no statistically significant differences in PASI reduction rates between PUVA and infliximab.
Conclusions: Retrospective analysis of registry data revealed that the primary efficacy of PUVA was superior to that of certain biologics. Prospective head-to-head studies of PUVA and biologics are warranted to confirm these observations.