Table III.
Reasons for discontinuing past treatments.a
| Discontinuation Reasons, n (%) | Systemic Treatment | Biologic | Phototherapy | ||||||
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| Methotrexate (N = 446) | Acitretin (N = 204) | Cyclosporine (N = 151) | Etanercept (N = 393) | Adalimumab (N = 200) | Infliximab (N = 99) | UVB (N = 590) | PUVA (N = 148) | P Valueb | |
| Did not work well enough | 94 (21.1) | 65 (31.9) | 37 (24.5) | 102 (26.0) | 68 (34.0) | 20 (20.2) | 136 (23.1) | 32 (21.6) | 0.004 |
| Worked well at first but stopped working well | 56 (12.6) | 25 (12.3) | 24 (15.9) | 126 (32.1) | 44 (22.0) | 21 (21.2) | 58 (9.8) | 20 (13.5) | < 0.001 |
| Non-life threatening side effects | 126 (28.3) | 74 (36.3) | 43 (28.5) | 48 (12.2) | 29 (14.5) | 24 (24.2) | 49 (8.3) | 31 (21.0) | < 0.001 |
| Life threatening side effectsd | 3 (0.7) | 2 (1.0) | 1 (0.7) | 2 (0.5) | 3 (1.5) | 9 (9.1) | 2 (0.3) | 2 (1.4) | < 0.001c |
| Developed illness unrelated to treatment | 19 (4.3) | 3 (1.5) | 8 (5.3) | 33 (8.4) | 15 (7.5) | 7 (7.1) | 9 (1.5) | 0 (0.0) | < 0.001 |
| Concern about safety of continuous treatment | 54 (12.1) | 9 (4.4) | 14 (9.3) | 18 (4.6) | 6 (3.0) | 2 (2.0) | 31 (5.3) | 17 (11.5) | < 0.001 |
| Psoriasis improved and prefer not to be on continuous treatment | 78 (17.5) | 26 (12.8) | 18 (11.9) | 16 (4.1) | 12 (6.0) | 5 (5.1) | 180 (30.5) | 33 (22.3) | < 0.001 |
| Too inconvenient | 10 (2.2) | 2 (1.0) | 0 (0.0) | 8 (2.0) | 1 (0.5) | 4 (4.0) | 180 (30.5) | 35 (23.7) | < 0.001 |
| Cannot afford treatmente | 19 (4.3) | 11 (5.4) | 9 (6.0) | 22 (5.6) | 9 (4.5) | 4 (4.0) | 68 (11.5) | 7 (4.7) | < 0.001 |
| Insurance deniede | 8 (1.8) | 3 (1.5) | 3 (2.0) | 21 (5.3) | 15 (7.5) | 7 (7.1) | 11 (1.9) | 7 (4.7) | < 0.001c |
| Delay in obtaining refills from doctor, pharmacy, or insurance companye | 43 (9.6) | 5 (2.5) | 6 (4.0) | 22 (5.6) | 20 (10.0) | 4 (4.0) | 7 (1.2) | 2 (1.4) | < 0.001 |
UVB, ultraviolet B; PUVA, oral psoralen plus ultraviolet A
The number of treatments totaled n = 2,231 since the N = 1,095 patients may each have received one or more past treatment. Percentages do not total 100% since patients may have more than one reason for discontinuing any particular treatment.
Chi-square test
Fisher’s exact test
Includes side effects that were life-threatening or required hospitalization
Correlations among these treatment discontinuation reasons are low (Pearson’s r = 0.25 between “cannot afford treatment” and “insurance denial”, r = 0.14 between “cannot afford treatment” and “delays in obtaining refills”), thus the role of “cannot afford treatment” on treatment discontinuation may not be entirely attributed to the other two reasons.