Tiago Torres1,2, Luis Puig3, Ron Vender4, Jensen Yeung5, José-Manuel Carrascosa6, Stefano Piaserico7, Paolo Gisondi8, Charles Lynde9, Paulo Ferreira10, Pedro Mendes Bastos10, Esteban Dauden11, Luiz Leite12, Joana Valerio12, Elena Del Alcázar-Viladomiu6, Eva Vilarrasa Rull3, Mar Llamas-Velasco11, Federico Pirro13,14, Francesco Messina7, Manfredo Bruni8, Gaetano Licata15, Federica Ricceri16, Alessia Nidegger17, Jan Hugo18, Asfandyar Mufti5, Athina-Ioanna Daponte19, Laetitia Teixeira20, Anna Balato21, Marco Romanelli22, Francesca Prignano16, Spyridon Gkalpakiotis18, Curdin Conrad17, Elizabeth Lazaridou19, Natalia Rompoti23, Marina Papoutsaki23, Miguel Nogueira24, Andrea Chiricozzi13,14. 1. Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal. torres.tiago@outlook.com. 2. Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal. torres.tiago@outlook.com. 3. Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 4. McMaster University, Hamilton, ON, Canada. 5. Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, ON, Canada. 6. Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain. 7. Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy. 8. Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy. 9. The Lynde Institute for Dermatology, Department of Medicine, University of Toronto, Toronto, Canada. 10. Hospital CUF Descobertas, Lisbon, Portugal. 11. Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain. 12. Clínica Médica Belém, Lisbon, Portugal. 13. Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy. 14. UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 15. Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy. 16. Department of Dermatological Science, Section of Dermatology, University of Florence, Florence, Italy. 17. Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland. 18. Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic. 19. Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece. 20. Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal. 21. Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, Italy. 22. Department of Dermatology, University of Pisa, Pisa, Italy. 23. 1st Departament of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece. 24. Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Abstract
BACKGROUND: Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. OBJECTIVE: The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. METHODS: This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. RESULTS: A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. CONCLUSION: The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab.
BACKGROUND: Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. OBJECTIVE: The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. METHODS: This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. RESULTS: A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. CONCLUSION: The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab.
Authors: Juul M P A van den Reek; Wietske Kievit; Robert Gniadecki; Jelle J Goeman; Jeffrey Zweegers; Peter C M van de Kerkhof; Marieke M B Seyger; Elke M G J de Jong Journal: J Invest Dermatol Date: 2015-07 Impact factor: 8.551
Authors: Z Z N Yiu; K J Mason; P J Hampton; N J Reynolds; C H Smith; M Lunt; C E M Griffiths; R B Warren Journal: Br J Dermatol Date: 2020-03-30 Impact factor: 9.302
Authors: Tiago Torres; Luis Puig; Ron Vender; Charles Lynde; Stefano Piaserico; Jose M Carrascosa; Paolo Gisondi; Esteban Daudén; Curdin Conrad; Pedro Mendes-Bastos; Paulo Ferreira; Luiz Leite; Justin D Lu; J Valerio; M Bruni; F Messina; A Nidegger; M Llamas-Velasco; E Del Alcazar; A Mufti; Kyra White; G Caldarola; Laetitia Teixeira; Paolo Romanelli; K Desai; Spyridon Gkalpakiotis; Marco Romanelli; Jensen Yeung; Miguel Nogueira; Andrea Chiricozzi Journal: Am J Clin Dermatol Date: 2021-03-30 Impact factor: 7.403