Adjunctive Chinese medicine therapy reduces relapse of psoriasis vulgaris after discontinuation of biologics: a prospective registry-based cohort study

Figures & data

Figure 1. Flow chart of the study.

Table 1. Characteristics of patients in the combination and biologics group before and after PSM.

Characteristic	Before PSM				After PSM
	Overall (N = 391)	Biologics (N = 203)	CM + Biologics (N = 188)	p Value	Biologics (N = 156)	CM + Biologics (N = 156)	p Value
Age				.723			.906
≤44	225 (57.5%)	113 (55.7%)	112 (59.6%)		90 (57.7%)	91 (58.3%)
45–59	104 (26.6%)	57 (28.1%)	47 (25%)		41 (26.3%)	38 (24.4%)
≥60	62 (15.9%)	33 (16.3%)	29 (15.4%)		25 (16%)	27 (17.3%)
Gender				.04			.815
Male	245 (62.7%)	137 (67.5%)	108 (57.4%)		99 (63.5%)	97 (62.2%)
Female	146 (37.3%)	66 (32.5%)	80 (42.6%)		57 (36.5%)	59 (37.8%)
BMI				.822			.929
<24	156 (39.9%)	78 (38.4%)	78 (41.5%)		64 (41%)	63 (40.4%)
24–27.9	161 (41.2%)	86 (42.4%)	75 (39.9%)		61 (39.1%)	64 (41%)
≥28	74 (18.9%)	39 (19.2%)	35 (18.6%)		31 (19.9%)	29 (18.6%)
Disease duration				.089			.85
≤2 years	45 (11.5%)	18 (8.9%)	27 (14.4%)		15 (9.6%)	16 (10.3%)
>2 years	346 (88.5%)	185 (91.1%)	161 (85.6%)		141 (90.4%)	140 (89.7%)
Family history				.868			1
No	303 (77.5%)	158 (77.8%)	145 (77.1%)		119 (76.3%)	119 (76.3%)
Yes	88 (22.5%)	45 (22.2%)	43 (22.9%)		37 (23.7%)	37 (23.7%)
Smoking				.114			.644
No	221 (56.5%)	107 (52.7%)	114 (60.6%)		95 (60.9%)	91 (58.3%)
Yes	170 (43.5%)	96 (47.3%)	74 (39.4%)		61 (39.1%)	65 (41.7%)
Drinking				.309			1
No	269 (68.8%)	135 (66.5%)	134 (71.3%)		109 (69.9%)	109 (69.9%)
Yes	122 (31.2%)	68 (33.5%)	54 (28.7%)		47 (30.1%)	47 (30.1%)
TCM syndrome				.137			.618
Blood-heat	192 (49.1%)	95 (46.8%)	97 (51.6%)		75 (48.1%)	75 (48.1%)
Blood-dryness	98 (25.1%)	47 (23.2%)	51 (27.1%)		39 (25%)	44 (28.2%)
Blood-stasis	101 (25.8%)	61 (30%)	40 (21.3%)		42 (26.9%)	37 (23.7%)
Baseline PASI				<.001			.685
<10	98 (25.1%)	34 (16.7%)	64 (34%)		34 (21.8%)	37 (23.7%)
≥10	293 (74.9%)	169 (83.3%)	124 (66%)		122 (78.2%)	119 (76.3%)
Types of biologics				.921			.851
Adalimumab	109 (27.9%)	57 (28.1%)	52 (27.7%)		46 (29.5%)	43 (27.6%)
Secukinumab	219 (56.0%)	112 (55.2%)	107 (56.9%)		82 (52.6%)	87 (55.8%)
Ixekizumab		34 (16.7%)	29 (15.4%)		28 (17.9%)	26 (16.7%)
Treatment duration				.683			.885
<48 weeks	317 (81.1%)	163 (80.3%)	154 (81.9%)		126 (80.8%)	127 (81.4%)
≥48 weeks	74 (18.9%)	40 (19.7%)	34 (18.1%)		30 (19.2%)	29 (18.6%)
Previous treatment				.954			1
No biologics	324 (82.9%)	168 (82.8%)	156 (83%)		131 (84%)	131 (84%)
Biologics	67 (17.1%)	35 (17.2%)	32 (17%)		25 (16%)	25 (16%)
PASI 90				.334			.768
Not achieve	70 (17.9%)	40 (19.7%)	30 (16%)		29 (18.6%)	27 (17.3%)
Achieve	321 (82.1%)	163 (80.3%)	158 (84%)		127 (81.4%)	129 (82.7%)

Figure 2. Cumulative relapse risk curves for the biologics and combination groups before (A) and after (B) PSM.

Figure 3. Forest map by multivariate Cox regression after PSM.

Table 2. Univariate and multivariate cox regression analyses of relapse before PSM.

		Univariate		Multivariate
		HR (95% CI)	p Value	HR (95% CI)	p Value
Group	Biologicals	Reference		Reference
	CM + biologicals	0.577 (0.410, 0.813)	.002	0.680 (0.479, 0.965)	.031
Age	≤44	Reference		Reference
	45 ∼ 59	1.45 (1.03–2.03)	.031	1.26 (0.90–1.77)	.182
	≥60	1.02 (0.66–1.59)	.925	1.06 (0.68–1.65)	.801
Gender	Male	Reference		Not selected
	Female	0.78 (0.57–1.07)	.13
BMI	<24	Reference		Not selected
	24 ∼ 27.9	1.01 (0.72–1.41)	.971
	≥28	1.16 (0.77–1.76)	.47
Disease duration	≤2 years	Reference		Reference
	>2 years	3.09 (1.52–6.29)	.002	3.26 (1.59–6.66)	.001
Family history	No	Reference		Not selected
	Yes	0.99 (0.69–1.42)	.953
Smoking	No	Reference		Not selected
	Yes	1.18 (0.87–1.59)	.294
Drinking	No	Reference		Not selected
	Yes	1.09 (0.79–1.51)	.584
TCM syndrome	Blood-heat	Reference		Not selected
	Blood-dryness	0.95 (0.66–1.38)	.8
	Blood-stasis	0.98 (0.68–1.41)	.896
Baseline PASI	<10	Reference		Not selected
	≥10	1.09 (0.77–1.54)	.642
Types of biologics	Adalimumab	Reference		Reference
	Secukinumab	0.52 (0.38–0.72)	p<.001	0.65 (0.46–0.92)	.016
	Ixekizumab	0.44 (0.27–0.72)	.001	0.55 (0.33–0.92)	.023
Treatment duration	<48 weeks	Reference		Reference
	≥48 weeks	0.60 (0.39–0.93)	.022	0.59 (0.38–0.92)	.021
Previous treatment	No biologics	Reference		Reference
	Biologics	1.42 (0.99–2.06)	.06	1.19 (0.82–1.73)	.365
PASI 90	Not achieve	Reference		Reference
	Achieve	0.36 (0.26–0.50)	<.001	0.40 (0.28–0.57)	<.001

Figure 4. Forest map by multivariate Cox regression in subgroup analysis.

Figure 5. Cumulative relapse risk curves in subgroup analysis. (A) Adalimumab; (B) Secukinumab; (c) Ixekizumab; (d) blood-heat; (e) blood-dryness; (f) blood-stasis.