{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:15:14Z","timestamp":1787008514810,"version":"build-2736575974"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000770","name":"The University of Manchester","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000770","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006483","name":"AbbVie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006483","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Real-world data evaluating effectiveness and persistence of systemic therapies for patients with psoriasis are limited.<\/jats:p>\n                    <jats:p>Objectives To determine the effectiveness and persistence of acitretin, ciclosporin, fumaric acid esters (FAEs) and methotrexate in patients with moderate-to-severe psoriasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), a prospective, multicentre pharmacovigilance register of patients with moderate-to-severe psoriasis receiving biologic and\/or conventional systemic therapies, were analysed. Eligible patients were \u2265 16\u2005years of age receiving a first course of acitretin, ciclosporin, FAEs or methotrexate between 2007 and 2021 with \u2265 6 months\u2019 follow-up. Effectiveness was defined as achieving absolute Psoriasis Area and Severity Index (aPASI) \u2264 2 reported \u2265 4 weeks after treatment start date until date of cessation. To identify baseline clinical variables associated with treatment effectiveness, we used multivariable logistic regression models estimating the adjusted odds ratio (aOR) of achieving aPASI \u2264 2. To describe drug persistence associated with ineffectiveness, occurrence of adverse events or other reasons for discontinuation, survival estimates with 95% confidence intervals (CIs) were obtained using a flexible parametric model. Results were obtained using multiple imputed data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 5430 patients were included in the analysis. Overall, 1023 (19%) patients were receiving acitretin, 1401 (26%) patients were on ciclosporin, 347 (6%) patients were on FAEs, and 2659 (49%) patients were receiving methotrexate at registration. The proportion of patients who achieved aPASI \u2264 2 was lower for those treated with acitretin [n = 118 (21%)] compared with those receiving ciclosporin [n = 233 (34%)], FAEs [n = 43 (29%)] and methotrexate [n = 372 (32%)]. Factors associated with ineffectiveness included prior experience to previous nonbiologic systemic therapies (acitretin) (aOR 0.64, 95% CI 0.42\u20130.96), male sex (methotrexate) (aOR 0.58, 95% CI 0.46\u20130.74), comorbidities (aOR 0.70, 95% CI 0.51\u20130.97) and alcohol consumption (\u2264 14 units per week) (ciclosporin) (aOR 0.70, 95% CI 0.50\u20130.98). Persistence associated with all reasons for discontinuation showed better survival for methotrexate compared with acitretin, ciclosporin and FAEs cohorts at 12\u2005months [survival estimate 46.1 (95% CI 44.0\u201348.3), 31.9 (95% CI 29.4\u201334.7), 30.0 (95% CI 27.5\u201332.4) and 35.0 (95% CI 29.9\u201340.9), respectively].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The real-world effectiveness and persistence of acitretin, ciclosporin, FAEs and methotrexate were generally low. Previous nonbiologic systemic therapies, male sex, comorbidities and alcohol consumption were risk factors associated with treatment ineffectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjd\/ljad004","type":"journal-article","created":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T23:45:55Z","timestamp":1673135155000},"page":"618-627","source":"Crossref","is-referenced-by-count":23,"title":["Effectiveness and persistence of acitretin, ciclosporin, fumaric acid esters and methotrexate for patients with moderate-to-severe psoriasis: a cohort study from BADBIR"],"prefix":"10.1093","volume":"188","author":[{"given":"Oras A","family":"Alabas","sequence":"first","affiliation":[{"name":"Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre , Manchester , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayleigh J","family":"Mason","sequence":"additional","affiliation":[{"name":"Primary Care Centre Versus Arthritis, School of Medicine, Keele University , Keele , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-074X","authenticated-orcid":false,"given":"Zenas Z N","family":"Yiu","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre , Manchester , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J","family":"Hampton","sequence":"additional","affiliation":[{"name":"Institute of Translational and Clinical Medicine, Medical School, Newcastle University, Department of Dermatology, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick J","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Institute of Translational and Clinical Medicine, Medical School, Newcastle University, Department of Dermatology, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust , Blackburn , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Bewley","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust & Queen Mary University , London , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip M","family":"Laws","sequence":"additional","affiliation":[{"name":"Leeds Dermatology Centre, Leeds Teaching Hospitals NHS Trust , Chapeltown Road, Leeds , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2918-6481","authenticated-orcid":false,"given":"Richard B","family":"Warren","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre , Manchester , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lunt","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre , Manchester , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine H","family":"Smith","sequence":"additional","affiliation":[{"name":"St John\u2019s Institute of Dermatology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust and King\u2019s College London , London , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E M","family":"Grif\ufb01ths","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre , Manchester , UK"},{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"BADBIR Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Barker","sequence":"additional","affiliation":[{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Morrison","sequence":"additional","affiliation":[{"name":"Details of the BADBIR study group are provided in the Supporting Information"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Bewley","sequence":"additional","affiliation":[{"name":"Details of the BADBIR study group are provided in the Supporting 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Venereol"},{"key":"2023112113512277500_ljad004-B11","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/bjd.18333","article-title":"Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study (the British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR)","volume":"182","author":"Mahil","year":"2020","journal-title":"Br J Dermatol"},{"key":"2023112113512277500_ljad004-B12","doi-asserted-by":"crossref","first-page":"971","DOI":"10.2340\/00015555-3245","article-title":"Absolute and relative Psoriasis Area and Severity Indices (PASI) for comparison of the efficacy of ixekizumab to etanercept and placebo in patients with moderate-to-severe plaque psoriasis: an integrated analysis of UNCOVER-2 and UNCOVER-3 outcomes","volume":"99","author":"Puig","year":"2019","journal-title":"Acta Derm 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