Z Z N Yiu1, K J Mason1, P J Hampton2,3, N J Reynolds2,3, C H Smith4, M Lunt5, C E M Griffiths1, R B Warren1. 1. Centre for Dermatology Research, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, UK. 2. Institute of Clinical and Translational Medicine, Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. 3. Department of Dermatology, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE2 4HH, UK. 4. St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK. 5. Versus Arthritis Centre for Epidemiology, The University of Manchester, Manchester, M13 9PT, UK.
Abstract
BACKGROUND: Real-world biologic drug survival is an important proxy measure for effectiveness. Predictors of drug survival may help patients with psoriasis choose between biologic therapies. OBJECTIVES: (i) To assess the relative drug survival of adalimumab, ustekinumab and secukinumab in patients with psoriasis. (ii) To investigate predictors of biologic drug survival. METHODS: A prospective cohort study was performed in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) between November 2007 and August 2019. We performed survival analysis and fitted a flexible parametric survival model for biologic discontinuation due to ineffectiveness. RESULTS: In total 9652 patients were included: 5543 starting on adalimumab (57·4%), 991 on secukinumab (10·3%) and 3118 on ustekinumab (32·3%). The overall drug survivals of adalimumab, secukinumab and ustekinumab in year 1 were 0·78 [95% confidence interval (CI) 0·77-0·79], 0·88 (95% CI 0·86-0·91) and 0·88 (95% CI 0·87-0·89), respectively. The adjusted hazard ratios (adjHRs) for discontinuation of adalimumab and secukinumab compared with ustekinumab were 2·11 (95% CI 1·76-2·54) and 0·67 (95% CI 0·40-1·11), respectively. The presence of psoriatic arthritis predicted for survival in the adalimumab and secukinumab cohorts (adjHR 0·67, 95% CI 0·51-0·88 and 0·70, 95% CI 0·40-1·24, respectively), but for discontinuation in the ustekinumab cohort (adjHR 1·42, 95% CI 1·12-1·81). Previous exposure to biologic therapies predicted for discontinuation in the ustekinumab and secukinumab cohorts (adjHR 1·54, 95% CI 1·26-1·89 and 1·49, 95% CI 0·91-2·45, respectively) and for survival in the adalimumab cohort (adjHR 0·71, 95% CI 0·55-0·92). CONCLUSIONS: Secukinumab and ustekinumab have similar sustained drug survival, while adalimumab has a lower drug survival in patients with psoriasis. Psoriatic arthritis and previous biologic experience were predictors with differential effects between the biologic therapies. What is already known about this topic? There is conflicting evidence over the real-world drug survival of secukinumab in patients with psoriasis. Data from registries to date suggest that secukinumab has a lower drug survival than that reported from clinical trials. What does this study add? This study found that secukinumab and ustekinumab had similar sustained drug survival in the real world, while the drug survival of adalimumab was lower, suggesting that the real-world drug survival of secukinumab is higher than previously reported. We found that psoriatic arthritis and previous biologic experience had differential effects on drug discontinuation in the three biologic cohorts. These predictors may help patients and clinicians choose the most appropriate biologic therapy.
BACKGROUND: Real-world biologic drug survival is an important proxy measure for effectiveness. Predictors of drug survival may help patients with psoriasis choose between biologic therapies. OBJECTIVES: (i) To assess the relative drug survival of adalimumab, ustekinumab and secukinumab in patients with psoriasis. (ii) To investigate predictors of biologic drug survival. METHODS: A prospective cohort study was performed in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) between November 2007 and August 2019. We performed survival analysis and fitted a flexible parametric survival model for biologic discontinuation due to ineffectiveness. RESULTS: In total 9652 patients were included: 5543 starting on adalimumab (57·4%), 991 on secukinumab (10·3%) and 3118 on ustekinumab (32·3%). The overall drug survivals of adalimumab, secukinumab and ustekinumab in year 1 were 0·78 [95% confidence interval (CI) 0·77-0·79], 0·88 (95% CI 0·86-0·91) and 0·88 (95% CI 0·87-0·89), respectively. The adjusted hazard ratios (adjHRs) for discontinuation of adalimumab and secukinumab compared with ustekinumab were 2·11 (95% CI 1·76-2·54) and 0·67 (95% CI 0·40-1·11), respectively. The presence of psoriatic arthritis predicted for survival in the adalimumab and secukinumab cohorts (adjHR 0·67, 95% CI 0·51-0·88 and 0·70, 95% CI 0·40-1·24, respectively), but for discontinuation in the ustekinumab cohort (adjHR 1·42, 95% CI 1·12-1·81). Previous exposure to biologic therapies predicted for discontinuation in the ustekinumab and secukinumab cohorts (adjHR 1·54, 95% CI 1·26-1·89 and 1·49, 95% CI 0·91-2·45, respectively) and for survival in the adalimumab cohort (adjHR 0·71, 95% CI 0·55-0·92). CONCLUSIONS:Secukinumab and ustekinumab have similar sustained drug survival, while adalimumab has a lower drug survival in patients with psoriasis. Psoriatic arthritis and previous biologic experience were predictors with differential effects between the biologic therapies. What is already known about this topic? There is conflicting evidence over the real-world drug survival of secukinumab in patients with psoriasis. Data from registries to date suggest that secukinumab has a lower drug survival than that reported from clinical trials. What does this study add? This study found that secukinumab and ustekinumab had similar sustained drug survival in the real world, while the drug survival of adalimumab was lower, suggesting that the real-world drug survival of secukinumab is higher than previously reported. We found that psoriatic arthritis and previous biologic experience had differential effects on drug discontinuation in the three biologic cohorts. These predictors may help patients and clinicians choose the most appropriate biologic therapy.
Authors: Tiago Torres; Luis Puig; Ron Vender; Jensen Yeung; José-Manuel Carrascosa; Stefano Piaserico; Paolo Gisondi; Charles Lynde; Paulo Ferreira; Pedro Mendes Bastos; Esteban Dauden; Luiz Leite; Joana Valerio; Elena Del Alcázar-Viladomiu; Eva Vilarrasa Rull; Mar Llamas-Velasco; Federico Pirro; Francesco Messina; Manfredo Bruni; Gaetano Licata; Federica Ricceri; Alessia Nidegger; Jan Hugo; Asfandyar Mufti; Athina-Ioanna Daponte; Laetitia Teixeira; Anna Balato; Marco Romanelli; Francesca Prignano; Spyridon Gkalpakiotis; Curdin Conrad; Elizabeth Lazaridou; Natalia Rompoti; Marina Papoutsaki; Miguel Nogueira; Andrea Chiricozzi Journal: Am J Clin Dermatol Date: 2022-08-17 Impact factor: 6.233
Authors: Zenas Z N Yiu; Kayleigh J Mason; Philip J Hampton; Nick J Reynolds; Catherine H Smith; Mark Lunt; Christopher E M Griffiths; Richard B Warren Journal: JAMA Dermatol Date: 2020-12-02 Impact factor: 10.282
Authors: Benjamin Lockshin; Angel Cronin; Ryan W Harrison; Robert R McLean; Laura Anatale-Tardiff; Russel Burge; Baojin Zhu; William N Malatestinic; Bilal Atiya; Mwangi J Murage; Gaia Gallo; Bruce Strober; Abby Van Voorhees Journal: Dermatol Ther Date: 2021-02-15 Impact factor: 2.851
Authors: Andrea Conti; Giovanni Damiani; Roberta Ruggeri; Giulia Odorici; Francesca Farnetani; Paolo Daniele Maria Pigatto; Giovanni Pellacani Journal: Dermatol Ther Date: 2021-08-16 Impact factor: 3.858