“Drug survival acts as a proxy marker for treatment effect and safety,” explained Dr Zenas Yiu (University of Manchester, UK). Only a few small studies reported on real-world drug survival of brodalumab and risankizumab. Therefore, Dr Yiu and his team conducted a cohort study using the BADBIR, a national pharmacovigilance registry including patients with psoriasis from the UK and the Republic of Ireland, with data collected between November 2007 and June 2023.
The analysis included 19,043 treatment courses from 11,877 participants with a median follow-up time of 2.3 years. “There were large cohorts for older biologics but smaller ones for the newer treatments, also the follow-up time is shorter,” Dr Yiu said. Most patients were treated with adalimumab (n=6,815), followed by ustekinumab (n=5,639). A further 832 patients were treated with risankizumab and 1,258 patients with guselkumab.
Therapy with the IL-23p19 inhibitors had the highest survival time with respect to effectiveness (guselkumab adjusted hazard ratio [aHR] 0.28; 95% CI 0.15–0.53; risankizumab 0.38; 95% CI 0.16–0.87), whereas adalimumab showed a lower survival compared with all other biologics (aHR 1.98; 95% CI 1.76–2.23). Biologics targeting IL-17 had similar drug survival earlier and lower drug survival later in follow-up compared with ustekinumab. Regarding safety, the results was similar.
Dr Yiu emphasised that the current study included the largest cohort of psoriasis patients on IL-23p19 inhibitors reported thus far. It showed that people with psoriasis persist with IL-23p19 inhibitors up to an estimated 21 weeks longer for effectiveness and 13 weeks longer for safety compared with other biologics over 2 years on average.
“These results may be valuable when discussing treatment choices where the patients value treatment effect longevity,” Dr Yiu concluded.