A prospective cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) investigated drug survival in the biologic treatment of psoriasis1. The study included data on patients with moderate-to-severe psoriasis from the web-based, longitudinal pharmacovigilance BADBIR registry between 2007 and 2021.
For the study, a treatment gap of more than 90 days defined therapy discontinuation. The investigation included data on the most widely used agents for psoriasis: adalimumab (TNF-inhibition), guselkumab (IL-23 inhibition), ustekinumab (IL-12/23 inhibition), ixekizumab and secukinumab (IL-17A inhibition). Drug survival was analysed at 1 and 2 years, and flexible parametric survival models were fitted to evaluate possible effect modification by variables like age, sex, body mass index, or history of prior biologic therapy.
As the investigated drugs have different time-spans on the market, the number of evaluated patients differed. For example, the adalimumab cohort comprised 6,607 patients, while the ixekizumab and the guselkumab groups had 703 and 730 subjects, respectively. Follow-up time also varied between 1.1 and 2.7 years, and the mean age of patients ranged from 45 to 48 years. The study population was predominantly male. As might be expected, the rate of biologic-naïve patients was comparatively lower for the newer therapeutic agents.
It extended from 74.8% in the adalimumab arm to 18.2% for ixekizumab and 23.6% for guselkumab. The functions of drug survival were determined according to ineffectiveness or adverse events as reasons for discontinuation. “Across all of the outcomes and years, guselkumab has the highest drug survival, and adalimumab the lowest,” highlighted Dr Zenas Yiu (University of Manchester, UK). At years 1 and 2, the survival functions for ineffectiveness were adalimumab 0.81/0.76, secukinumab 0.86/0.75, ustekinumab 0.89/0.83, ixekizumab 0.86/0.75, and guselkumab 0.94/0.92.
The respective results for therapy discontinuation as a result of side effects were adalimumab 0.91/0.88, secukinumab 0.94/0.0.90, ustekinumab 0.94/0.91, ixekizumab 0.92/0.87, and guselkumab 0.96/0.93. “You can see very good drug survival for all our treatments for safety but again it demonstrates that guselkumab has higher drug survival compared with our comparators,” Dr Yiu commented. He further pointed out that an effect modification was detected by previous biologic treatment history.
“Guselkumab had the highest drug survival for both effectiveness and safety out of the treatments looked at here. Previous biologic experience was an effect modifier for discontinuation due to ineffectiveness and this reduction-effect for drug survival over treatment lines seems to be most pronounced for the IL-17A inhibitors,” Dr Yiu concluded.