Factors affecting the efficacy of drug therapy in patients with plaque psoriasis

Relevance. The selection and modification of drug therapy for patients with plaque psoriasis does not have a specific solution for practicing specialists. Factors have been identified that can worsen the course of the disease when therapies with proven clinical efficacy are used and can even increase the severity and prevalence of the psoriatic process, leading to the development of erythroderma or resistance to the therapy. This article analyzed the actual clinical practice of plaque psoriasis therapy and the influence of concomitant diagnoses on the choice of therapy by physicians among patients who were treated in skin and venereal disease dispensaries in the Central Federal District from 2022 to 2023. Objective. To conduct a pharmacoepidemiological analysis of drug prescriptions and the volume of their consumption for plaque psoriasis using frequency analysis and analysis of average daily doses at the outpatient and inpatient stages of treatment, followed by a search for patterns. Materials and methods. An open, non-randomized, cross-sectional prospective study of outpatient records and hospital discharge summaries of 336 patients diagnosed with L40.0 plaque psoriasis was conducted over 2 years. Patients were surveyed by their physicians regarding their adherence to the physician recommendations using a questionnaire on adherence to therapy. The presence of complications of the primary diagnosis, concomitant diagnoses, and factors influencing the prescription of methotrexate and monoclonal antibodies were analyzed. Results. Patients prescribed methotrexate drugs had significantly more concomitant diseases (p <0.05). In addition to the primary diagnosis, patients treated with methotrexate had significantly less of the following: psoriatic arthritis, polyarthritis, spondyloarthritis, dactylitis, enthesitis, and psoriatic onychodystrophy compared with the group of patients who were prescribed genetically engineered biological drugs (p <0.05). The multivariate analysis revealed the influence of skin lesion severity and patient adherence on therapy choice. Conclusions. Among patients prescribed genetically engineered drugs, concomitant complications of an arthropathic nature were significantly more common — in 32.5 % of cases, versus 18.2 % in the group of patients on methotrexate (p <0.05). Therefore, the choice in favor of monoclonal antibodies in most cases was due to the presence of arthropathic psoriatic complications, skin lesion severity, younger age, and high adherence to the innovative therapy prescribed by the doctor (p <0.05).