Analysis of duration of remission of psoriasis after discontinuation of targeted therapy: Search for predictors of early relapse of disease

Abstract

Purpose of the study. To establish patterns of changes in the duration of the remission period in patients suffering from severe psoriasis after discontinuation of targeted therapy.Materials and methods. The work was carried out in the design of an open randomized interventional prospective study and was carried out in two successive stages. To calculate indicators of the expected duration of the remission period, Kaplan – Meier ‘survival’ analysis was used with the construction of ‘survival’ tables and curves assessing the significance of differences using the Mantel – Cox log-rank test. Significant factors presumably influencing the increase in the cumulative risk of relapse were determined by multivariate Cox regression.Results. The longest period of remission was typical for patients who were prescribed systemic therapy with guselkumab – 33.5 weeks, the second longest period of remission was ustekinumab – 29.1 weeks, the third – secukinumab – 24.7 weeks. The average duration of remission after discontinuation of adalimumab used for a year was 17.4 weeks. The worst disease-free period was recorded for apremilast – 6.9 weeks (p < 0.001 for all comparisons). Significant predictors of early onset of psoriasis relapse were the following factors: the presence of a family history, failure to achieve the PASI 75 indicator by the 16th week of treatment, delayed prescription of targeted therapy (more than 3 years after the diagnosis of ‘severe psoriasis vulgaris’), high values of the PASI index at the time of initiation of systemic therapy and long duration of illness.Conclusions. Resumption of systemic treatment was required in 25.8 %, 35.3 %, and 12.1 % of patients within the first 6 months after discontinuation of ustekinumab, secukinumab, and guselkumab, respectively. When patients received adalimumab, re-prescription of targeted therapy was required in 33.3 % of cases 4 months after discontinuation, and when prescribed apremilast – in 64.5 % of cases already 2 months after discontinuation. Among all systemic drugs examined, the IL‑23 inhibitor (guselkumab) was associated with the longest period of psoriasis remission after discontinuation of targeted treatment. The identified predictors of early disease relapse indicate the importance of personalized targeted therapy and open up the possibility of prognostic assessment of the expected duration of the disease-free period after discontinuation of systemic treatment.