Impact of biologic therapies on quality of life of psoriasis patients: results from the British Association of Dermatologists Biologic Interventions Register

The quality of life (QoL) of psoriasis patients receiving biologic therapies in the "real-world" is relatively unknown. We assessed the impact of biologics on QoL & studied potential predictors for improved QoL, using a cohort of 2152 psoriasis patients (adalimumab (n=1239), etanercept (n=517) & ustekinumab (n=396); 81% were biologic-naïve) registered with the British Association of Dermatologists Biologic Interventions Register & followed-up for ≥6-months. Changes in QoL were assessed using the Dermatology Life Quality Index (DLQI) & EuroQoL-5D (EQ5D) at 6 & 12-months. For the entire cohort, the median (interquartile range) DLQI & EQ5D utility score improved from 18(13-24) & 0.7(0.6-0.8) at baseline to 2(0-7) & 0.9(0.7-1.0) at 6-months (p<0.0001), respectively; 46% & 54% of patients achieved a DLQI of 0/1 & a clinically meaningful change of ≥0.05 in their EQ5D. Improvements were generally maintained at 12-months. At 6-months the multivariable regression models showed that patients who were obese, with multiple comorbidities, & with lower QoL at baseline were significantly less likely to show either EQ5D improvements or achieve a DLQI of 0/1. As compared with adalimumab, patients on etanercept were less likely to achieve a DLQI of 0/1, however, there was no significant difference between the three biologics in improvement in EQ5D. Age, smoking & psoriatic arthritis were determinants of poor improvement in EQ5D. Similar factors were associated with QoL improvement at 12-months. In routine clinical practice, biologics were associated with improvement in QoL in psoriasis patients. The results of this study will help to inform clinical decisions in psoriasis management.