Use of fumaric acid derivatives (FADs) in Italian reference centres for psoriasis

BACKGROUND: Several therapies are available for psoriasis, including in some countries oral fumaric acid derivatives (FA Ds). Even if FA Ds are not available in the Italian market, they can be prescribed and reimbursed by the National Health Service, on request from the treating physician, when considered as a valuable option in selected patient. METHODS: We performed a retrospective analysis of the PsoReal registry data, restricted to adult psoriatic patients enrolled between 2009 and 2017. Demographic and clinical data were collected together with information on systemic therapies prescribed for psoriasis, drug shifts and adverse effects. We focused our analysis on FA Ds compared with other systemic drugs. RESULTS: From the registry data, a total of 17,064 patients were extracted, and 11,592 patients (67.9%), fulfilled inclusion criteria. The majority of them had chronic plaque psoriasis, the mean disease duration was 17.1 +/- 12.6 years, and the mean PASI was 17.8 +/- 10.9, with 51.5% presenting a moderate Ps (PASI between 10 and 20). A total of 36 patients (0.3%) were treated by FA Ds. The average treatment duration of conventional (9.0 +/- 10.0 months) and biological agents (13.7 +/- 11.6 months) was lower compared to the duration of FA Ds (28.1 +/- 20.1, P value<0.001). FA Ds were used at an average dosage of 361.0 +/- 146.3 mg/day and FA Ds treated patients displayed an overall lower healthcare cost compared with other drugs. CONCLUSIONS: The current study confirms previous European data about efficacy and safety of FADs and suggests a decrease of healthcare costs for FA Ds treated patients as compared to other treatments.