Supplementary Material for: Patient Adherence to Biologic Agents in Psoriasis

<b><i>Background:</i></b> Low adherence to therapies in psoriasis decreases treatment outcomes and increases the total health care costs. In spite of the wide use of biologic agents, patients' adherence to these drugs has not been extensively investigated. <b><i>Objective:</i></b> The aim of this study is to measure adherence to the biologic drugs in a population of patients treated for psoriasis vulgaris using the medication possession ratio (MPR) index and to survey patients' attitudes to the treatment. <b><i>Methods:</i></b> This is a single-center study on 247 patients with psoriasis vulgaris treated with adalimumab (n = 113), etanercept (n = 39), and ustekinumab (n = 95). MPR calculation was calculated monthly based on the hospital records documenting the dispensing of biologics to the patients. Clinical data [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), presence of psoriatic arthritis, concomitant treatment, and cause for treatment discontinuation] were obtained from the national database DERMBIO. Patients' attitudes and beliefs were measured using the Medication Adherence Rating Scale (MARS). <b><i>Results:</i></b> A total of 93.5% of all patients had an MPR ≥0.8, indicating very good adherence. MPR was independent of patients' age, gender, median PASI or DLQI score, concomitant diagnosis of psoriatic arthritis, or treatment with methotrexate. MPR for etanercept was slightly lower than that for ustekinumab and adalimumab. The MARS questionnaire documented satisfactory understanding of the treatment and its adverse effects, and positive attitudes to the treatment. <b><i>Conclusion:</i></b> Adherence to biologic therapies is very high in patients with psoriasis, which is consistent with a positive attitude to the treatment.

背景：银屑病（psoriasis）患者对治疗方案的依从性不足，会降低治疗结局并增加整体医疗成本。尽管生物制剂已被广泛应用，但目前针对患者依从这类药物的相关研究仍未得到充分探索。
目的：本研究旨在以药物持有率（medication possession ratio, MPR）为评估指标，对接受生物制剂治疗的寻常型银屑病（psoriasis vulgaris）患者的药物依从性进行量化，并调研患者对该治疗方案的态度。
方法：本研究为单中心临床研究，共纳入247例接受生物制剂治疗的寻常型银屑病患者，其中接受阿达木单抗（adalimumab）治疗者113例、依那西普（etanercept）治疗者39例、乌司奴单抗（ustekinumab）治疗者95例。研究基于记录患者生物制剂配发情况的医院病历，每月计算药物持有率。临床数据[包括银屑病面积与严重性指数（Psoriasis Area and Severity Index, PASI）、皮肤病生活质量指数（Dermatology Life Quality Index, DLQI）、银屑病关节炎患病情况、伴随治疗方案及停药原因]来源于国家数据库DERMBIO。患者的治疗态度与认知则通过药物依从性评定量表（Medication Adherence Rating Scale, MARS）进行测评。
结果：总计93.5%的患者药物持有率≥0.8，提示依从性极佳。药物持有率与患者年龄、性别、中位PASI评分或DLQI评分、伴随银屑病关节炎诊断，以及是否接受甲氨蝶呤治疗均无显著相关性。依那西普组的药物持有率略低于乌司奴单抗组与阿达木单抗组。MARS问卷结果显示，患者对治疗方案及其不良反应均有充分了解，且对治疗持积极态度。
结论：银屑病患者对生物制剂治疗的依从性极高，这与患者对治疗的积极态度相一致。