Psoriasis is an inflammatory skin disease with a chronic course-relapsing, characterized by the presence of patches or plaques erythematous, scaly, with a prevalence between 0.5 and 4.5% of the general population. Over the past decade, the use of biological drugs (etanercept, infliximab, adalimumab, and ustekinumab efalizumab, the latter now out of business) has revolutionized the therapeutic management of patients with severe psoriasis. Biological drugs are a third-line therapy for patients who do not respond to common systemic and topical therapies. They have proven efficacy, in general allow to obtain a remission of the disease in a short time, however they have a higher cost compared to traditional therapies. The remission of the disease in all patients is not lasting and unfortunately the loss of the initial clinical response is also common in those who presented an excellent response, making it necessary to "shift" to another biologic drug. Currently there are no indicators of therapeutic response that allow you to know in advance which patients will respond to the drug. In this work were considered 72 patients referred to the Dermatology Clinic IRCCS Policlinico San Matteo in Pavia from July 2005 to December 2014 suffering from moderate to severe psoriasis treated with biologics. We analyzed the effectiveness of each medication, the loss of effectiveness over time or failure to reply to the same biologic drug, PASI and the cost of care for the patient in order to foster an environment of health expenditure responsible and good practice clinic.
La psoriasi è una patologia cutanea infiammatoria a decorso cronico-recidivante, caratterizzata dalla presenza di chiazze o placche eritemato-desquamanti, con una prevalenza compresa tra lo 0,5 e il 4,5% della popolazione generale. Negli ultimi dieci anni, l'utilizzo dei farmaci biologici (etanercept, infliximab, adalimumab, ustekinumab ed efalizumab, quest'ultimo ormai fuori commercio) ha rivoluzionato la gestione terapeutica del paziente affetto da psoriasi grave. I farmaci biologici sono una terza linea terapeutica per i pazienti non responsivi alle comuni terapie topiche e sistemiche. Hanno un'efficacia comprovata, in genere permettono di ottenere una remissione della patologia in breve tempo, tuttavia presentano un costo più elevato rispetto alle terapie tradizionali. La remissione della patologia non in tutti i pazienti è duratura e purtroppo la perdita della risposta clinica iniziale è frequente anche in coloro che hanno presentato una risposta eccellente, rendendo necessario lo “shift” verso un altro farmaco biologico. Attualmente non ci sono indicatori di risposta terapeutica che permettono di sapere in anticipo quale paziente risponderà al farmaco. In questo lavoro sono stati presi in considerazione 72 pazienti afferenti alla Clinica Dermatologica IRCCS Policlinico San Matteo di Pavia dal Luglio 2005 al Dicembre 2014 affetti da psoriasi moderata-grave e trattati con farmaci biologici. Sono stati analizzati l’efficacia di ogni singolo farmaco, la perdita di efficacia nel tempo o la mancata risposta al farmaco biologico stesso, l’indice PASI e il costo terapeutico per paziente al fine di promuovere un ambiente di spesa sanitaria responsabile e di buona pratica clinica.
VALUTAZIONE DELL'EFFICACIA RETROSPETTIVA DEI FARMACI BIOLOGICI NELLA PSORIASI RAPPORTANDO I DATI CLINICI ALL'ASPETTO FARMACOECONOMICO
FORNI, PIER VALENTINA
2014/2015
Abstract
Psoriasis is an inflammatory skin disease with a chronic course-relapsing, characterized by the presence of patches or plaques erythematous, scaly, with a prevalence between 0.5 and 4.5% of the general population. Over the past decade, the use of biological drugs (etanercept, infliximab, adalimumab, and ustekinumab efalizumab, the latter now out of business) has revolutionized the therapeutic management of patients with severe psoriasis. Biological drugs are a third-line therapy for patients who do not respond to common systemic and topical therapies. They have proven efficacy, in general allow to obtain a remission of the disease in a short time, however they have a higher cost compared to traditional therapies. The remission of the disease in all patients is not lasting and unfortunately the loss of the initial clinical response is also common in those who presented an excellent response, making it necessary to "shift" to another biologic drug. Currently there are no indicators of therapeutic response that allow you to know in advance which patients will respond to the drug. In this work were considered 72 patients referred to the Dermatology Clinic IRCCS Policlinico San Matteo in Pavia from July 2005 to December 2014 suffering from moderate to severe psoriasis treated with biologics. We analyzed the effectiveness of each medication, the loss of effectiveness over time or failure to reply to the same biologic drug, PASI and the cost of care for the patient in order to foster an environment of health expenditure responsible and good practice clinic.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/25039