Injections Site Reactions and Biologics for Psoriasis: A Questionnaire Based Real Life Study

Figures & data

Figure 1 Injections site reactions questionnaire (ISRs).

Table 1 Clinical and Demographics Characteristics of Our Population

	Anti-TNF-Alpha				Anti-IL12/23	Anti-IL17			Anti-IL23			Total
	Adalimumab	Etanercept	Golimumab	Certolizumab	Ustekinumab	Secukinumab	Ixekizumab	Brodalumab	Guselkumab	Tildrakizumab	Risankizumab
Patients n (%)	32 (13.7%)	20 (8.5%)	4 (1.7%)	20 (8.5%)	22 (9.4%)	20 (8.5%)	36 (15.4%)	20 (8.5%)	20 (8.5%)	20 (8.5%)	20 (8.5%)	234 (100%)
Male	14	10	2	2	6	12	22	10	12	12	12	114 (48.7%)
Female	18	10	2	18	16	8	14	10	8	8	8	120 (51.3%)
Age (mean age ± DS)	43.9 years ± 18.6	55.5 years ± 16.18	58 years ± 6	34.8 years ± 11.6	59 years ± 15.17	58.9 years ± 15.28	52.44 years ± 8.4	45 years ± 15.42	57.4 years ± 9.18	52.6 years ± 12.13	50.2 years ± 13.89	51.2 years ± 15.6
Psoriatic Arthritis	6 (2.5%)	10 (4.3%)	4 (1.7%)	6 (2.5%)	0 (0%)	18 (7.7%)	12 (5.1%)	0 (0%)	6 (2.5%)	12 (5.1%)	2 (0.8%)	76 (32.5%)
Bionaive n (%)	28 (11.9%)	18 (7.7%)	0 (0%)	20 (8.5%)	14 (5.9%)	10 (4.3%)	16 (6.8%)	18 (7.7%)	16 (6.8%)	18 (7.7%)	8 (3.4%)	166 (70.9%)
Comorbidity	14 (6%)	6 (2.6%)	6 (2.6%)	6 (2.6%)	14 (6%)	18 (7.7%)	28 (12%)	0 (0%)	24 (10.3%)	12 (5.1%)	18 (7.7%)	146 (62.4%)
Diabetes	0 (0%)	0 (0%)	0 (0%)	2 (0.85%)	4 (1.7%)	2 (0.85%)	8 (3.4%)	0 (0%)	4 (1.7%)	0 (0%)	2 (0.85%)	22 (9.4%)
Cardiovascoular disease	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (1.7%)	2 (0.85%)	0 (0%)	0 (0%)	2 (0.85%)	2 (0.85%)	10 (4.3%)
Arterial hypertension	8 (3.4%)	0 (0%)	2 (0.85%)	2 (0.85%)	6 (2.5%)	8 (3.4%)	10 (4.3%)	0 (0%)	6 (2.5%)	6 (2.5%)	2 (0.85%)	50 (21.4%)
Dyslipidaemia	2 (0.85%)	0 (0%)	0 (0%)	0 (0%)	2 (0.85%)	2 (0.85%)	2 (0.85%)	0 (0%)	4 (1.7%)	2 (0.85%)	2 (0.85%)	16 (6.8%)
Others	4 (1.7%)	6 (2.5%)	4 (1.7%)	2 (0.85%)	2 (0.85%)	2 (0.85%)	6 (2.5%)	0 (0%)	10 (4.3%)	2 (0.85%)	10 (4.3%)	48 (20.5%)
Mean Psoriasis Duration
≤1y	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	2 (0.85%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	2 (0.85%)
1–5ys	8 (3.4%)	4 (1.7%)	0 (0%)	2 (0.85%)	0 (0%)	8 (3.4%)	2 (0.85%)	6 (2.5%)	2 (0.85%)	8 (3.4%)	2 (0.85%)	42 (17.9%)
≥5ys	24 (10.2%)	16 (6.8%)	4 (1.7%)	18 (7.7%)	22 (9.4%)	12 (5.1%)	32 (13.7%)	14 (5.9%)	18 (7.7%)	12 (5.1%)	18 (7.7%)	190 (81.2%)

Table 2 Analysis of Injection Site Reactions (ISRs) and Suspensions or Delays of Administration Due to Anxiety or Fear of Injections, by Drug Class and Individual Drug

	Anti-TNF-Alpha				Anti-IL12/23	Anti-IL17			Anti-IL23			Total
	Adalimumab	Etanercept	Golimumab	Certolizumab	Ustekinumab	Secukinumab	Ixekizumab	Brodalumab	Guselkumab	Tildrakizumab	Risankizumab
	32	20	4	20	22	20	36	20	20	20	20	234
Pain n (%)	14 (43.75%)	10 (50%)	2 (50%)	10 (50%)	2 (9%)	2 (10%)	26 (72.2%)	4 (20%)	4 (20%)	6 (30%)	4 (20%)	84 (35.9%)
n (%) of patients with pain per drug class	36 (47.4%)				2 (9%)	32 (42.1%)			14 (23.3%)
Intensity n (% on patients experienced ISRs)
VAS 1–4 (mild)	4 (28.6%)	6 (60%)	0 (0%)	0 (0%)	2 (100%)	2 (100%)	6 (23%)	0 (0%)	0 (0%)	6 (100%)	2 (50%)	28 (33.4%)
VAS 5–7 (moderate)	6 (42.85%)	2 (20%)	2 (100%)	4 (40%)	0 (0%)	0 (0%)	12 (46.2%)	2 (50%)	2 (50%)	0 (0%)	2 (50%)	32 (38%)
VAS 8–10 (severe)	4 (28.6%)	2 (20%)	0 (0%)	6 (60%)	0 (0%)	0 (0%)	8 (30.8%)	2 (50%)	2 (50%)	0 (0%)	0 (0%)	24 (28.6%)
Mean VAS	6	5	6	8	4	2	6	7	8	2	5	6
Most frequent VAS category per drug class	VAS 5–7 (moderate)				VAS 1–4 (mild)	VAS 5–7 (moderate)			VAS 1–4 (mild)
Intensity n Duration n (% on patients experienced ISRs)
< 1 h	12 (85.7%)	8 (80%)	2 (100%)	8 (80%)	0 (0%)	2 (100%)	22 (84.6%)	0 (0%)	4 (100%)	6 (100%)	4 (100%)	68 (81%)
1–24 h	2 (14.3%)	0 (0%)	0 (0%)	2 (20%)	2 (100%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	6 (7.1%)
24–72 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (100%)	0 (0%)	0 (0%)	0 (0%)	4 (4.8%)
> 72 h	0 (0%)	2 (20%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (15.4%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	6 (7.1%)
Most frequent pain duration per drug class	<1 h				1–24 h	<1 h			<1 h
Burning n (%)	12 (37.5%)	4 (20%)	0 (0%)	4 (20%)	0 (0%)	2 (10%)	28 (77.77%)	4 (20%)	6 (30%)	4 (20%)	2 (10%)	66 (28.2%)
n (%) of patients with burning per drug class	20 (26.3%)				0 (0%)	34 (44.7%)			12 (20%)
Intensity n Duration n (% on patients experienced ISRs)
< 1 h	12 (100%)	4 (100%)	0 (0%)	4 (100%)	0 (0%)	2 (100%)	26 (92.9%)	0 (0%)	6 (100%)	4 (100%)	2 (100%)	60 (90.9%)
1–24 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (100%)	0 (0%)	0 (0%)	0 (0%)	4 (6.1%)
24–72 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)
> 72 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	2 (7.1%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	2 (3%)
Most frequent burning duration per drug class	<1 h					<1 h			<1h
Erythema n (%)	4 (12.5%)	0 (0%)	0 (0%)	4 (20%)	2 (9%)	4 (20%)	14 (38.89%)	4 (20%)	6 (30%)	0 (0%)	4 (20%)	42 (17.9%)
n (%) of patients with erythema per drug class	8 (10.5%)					2 (9%)			22 (28.9%)
Intensity n Duration n (% on patients experienced ISRs)
< 1 h	2 (50%)	0 (0%)	0 (0%)	2 (50%)	0 (0%)	2 (50%)	2 (14.3%)	0 (0%)	4 (66.7%)	0 (0%)	2 (50%)	14 (33.3%)
1–24 h	0 (0%)	0 (0%)	0 (0%)	2 (50%)	2 (100%)	2 (50%)	0 (0%)	4 (100%)	2 (33.3%)	0 (0%)	2 (50%)	14 (33.3%)
24–72 h	2 (50%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	12 (85.7%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	14 (33.3%)
> 72 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)
Most frequent erythema duration per drug class	<1h					1–24 h			24–72 h
Swelling n (%)	14 (43.75%)	4 (20%)	0 (0%)	8 (40%)	0 (0%)	2 (10%)	30 (83.33%)	4 (20%)	4 (20%)	2 (10%)	6 (30%)	74(31.62%)
n (%) of patients with swelling per drug class	26 (34.2%)					0 (0%)			36 (47.4%)
Intensity n Duration n (% on patients experienced ISRs)
< 1 h	6 (42.8%)	4 (100%)	0 (0%)	2 (25%)	0 (0%)	2 (100%)	4 (13.3%)	2 (50%)	0 (0%)	2 (100%)	2 (33.3%)	24 (32.4%)
1–24 h	4 (28.6%)	0 (0%)	0 (0%)	6 (75%)	0 (0%)	0 (0%)	14 (46.7%)	2 (50%)	4 (100%)	0 (0%)	4 (66.7%)	34 (45.9%)
24–72 h	4 (28.6%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	8 (26.7%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	12 (16.2%)
> 72 h	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (13.3%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	4 (5.4%)
Most frequent swelling duration per drug class	<1 h								1–24 h
Suspension or delay in therapy due to anxiety and/or fear of injection	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	8 (22.2%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	8 (3.4%)

Figure 2 Percentages of injection site reactions (ISRs): (A) per drug class; (B) per individual drug.