Treatment sequences in moderate-to-severe psoriasis: a hospital-based retrospective analysis

BackgroundFor moderate-to-severe psoriasis, clinical guidelines recommend biologic treatments after failure of at least one traditional systemic therapy. Biologics target different pathways, but a common challenge is loss of efficacy, often requiring a switch. This study explores real-world therapeutic management of moderate-to-severe psoriasis, focusing on biologic treatments.MethodsA retrospective study was conducted using health records of adult patients currently receiving biologics at Sant'Orsola Hospital in Bologna. Therapeutic sequences were investigated using state sequence analysis. Within-sequence Shannon entropy was calculated and used as the outcome in linear regression models. A directed acyclic graph informed the hierarchical regression models to identify factors influencing treatment duration.ResultsThe cohort included 364 patients. Adalimumab was the most common first-line biologic (27%), followed by secukinumab (18%) and etanercept (16%). Nearly half of patients (48%) switched treatments. Increasing age was associated with lower sequence heterogeneity (beta = -0.001, p = 0.002). Ustekinumab demonstrated the longest median treatment duration (1,841 days), while etanercept had the shortest (639 days). After adjusting for confounding variables, ustekinumab maintained its positive effect on treatment duration (beta = 0.285, p = 0.009).ConclusionThe treatment duration for ustekinumab was encouraging, supporting its potential role as a durable option in these patients.