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Gollins CE, Vincent R, Fahy C, McHugh N, Tillett W. Effectiveness of sequential lines of biologic and targeted small molecule drugs in psoriasis: A systematic review and meta-analysis. SKIN HEALTH AND DISEASE 2024; 4:e350. [PMID: 38577060 PMCID: PMC10988728 DOI: 10.1002/ski2.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024]
Abstract
To assess current evidence of effectiveness of sequential lines of biologic and targeted small molecule drugs for psoriasis beyond first line. A systematic search of the literature (Medline, Embase and bibliographic) was undertaken in October and December 2022 to find all studies assessing effectiveness of biologics and targeted small molecules when used beyond first-line in adults with psoriasis (PROSPERO CRD42022365298). Data extraction and a bias assessment (Risk Of Bias In Non-randomized Studies-of Interventions/Cochrane RoB2) were undertaken for all included studies. A random effects proportional meta-analysis was undertaken for PASI75/90/100 at 12-16 weeks for each line of treatment (1st to 4th). Of 2666 abstracts identified, a full text review was undertaken of 177 studies; 20 manuscripts met eligibility criteria. Twenty studies were included in the analysis: 19 observational studies and one sub analysis of a RCT; n = 6495 (average age 49.7 years, female 35.1%). Eleven studies assessed second line biologic, nine assessed third + line. A meta-analysis of PASI75 at 12-16 weeks found pooled effect percentage achieving PASI75 of 61%, 56%, 79% and 61% in 1st, 2nd, 3rd and 4th line biologics respectively. Meta-analyses of PASI90/100 also found no evidence of diminished effectiveness with sequential lines (PASI90 46.1%, 39.9%, 55.8% and 33.7% and PASI100 36.7%, 30.3%, 46.7% and 30.4% in 1st to 4th line respectively). Available evidence for effectiveness of biologics beyond first line in psoriasis is predominantly observational, at high risk of bias and of low quality. There is very limited data for effectiveness beyond second line. Evidence indicates that biologics can be effective to fourth-line.
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Affiliation(s)
- Charlotte E. Gollins
- Dermatology DepartmentRoyal United Hospitals Bath NHS Foundation TrustBathUK
- Department of Life SciencesCentre for Therapeutic InnovationUniversity of BathBathUK
| | - Rosie Vincent
- Dermatology DepartmentRoyal United Hospitals Bath NHS Foundation TrustBathUK
- University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Caoimhe Fahy
- Dermatology DepartmentRoyal United Hospitals Bath NHS Foundation TrustBathUK
| | - Neil McHugh
- Department of Life SciencesCentre for Therapeutic InnovationUniversity of BathBathUK
| | - William Tillett
- Department of Life SciencesCentre for Therapeutic InnovationUniversity of BathBathUK
- Royal National Hospital for Rheumatic DiseasesBathUK
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2
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Kim M, Yang S, Kim BR, Youn SW. Epidermal Hyperproliferation With Less Prominent Dermal Inflammation Is the Unique Histopathological Feature of the Refractory Lesions in Psoriasis Treated With Ustekinumab. Am J Dermatopathol 2022; 44:267-271. [PMID: 34726183 DOI: 10.1097/dad.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although ustekinumab (UST) shows excellent efficacy in treating psoriasis, not all patients have a complete clearance rate. The purpose of this study was to investigate the histopathological characteristics of refractory psoriasis lesions in patients with excellent response to UST. Fifty-seven patients with newly diagnosed psoriasis and 66 patients with a 75% reduction in the Psoriasis Area and Severity Index score after UST treatment were included. Computer-aided image analysis was performed to measure the epidermal thickness, horny layer thickness, number of dermal vessels, and dermal inflammatory cell infiltration rate. Parakeratosis was scored using a 4-point scale. These measurements were compared between the refractory lesions of UST-treated patients and the untreated lesions of newly diagnosed patients after the adjustment for confounding factors. The dermal inflammatory cell infiltration rate was significantly lower in the refractory lesions (P = 0.022). Meanwhile, the epidermal thickness, horny layer thickness, grade of parakeratosis, and dermal vessel count did not differ between the groups (P = 0.125, 0.719, 0.542, and 0.758, respectively). Subgroup analyses were performed within the UST-treated group after dividing them into 2 groups according to the number of treatments or treatment response rates. None of these features were significantly different between the subgroups. This study suggests that the reduction of dermal inflammation by UST was not sufficient to ameliorate the epidermal changes and implies the role of the interleukin-23-independent downstream cytokine pathway in causing the refractory lesions among patients who responded well to UST. The continuation of UST treatment might not further improve epidermal alterations.
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Affiliation(s)
- Minsu Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Seungkeol Yang
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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3
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Elberdín L, Fernández-Torres RM, Paradela S, Mateos M, Blanco E, Balboa-Barreiro V, Gómez-Besteiro MI, Outeda M, Martín-Herranz I, Fonseca E. Biologic Therapy for Moderate to Severe Psoriasis. Real-World Follow-up of Patients Who Initiated Biologic Therapy at Least 10 Years Ago. Dermatol Ther (Heidelb) 2022; 12:761-770. [PMID: 35226302 PMCID: PMC8941069 DOI: 10.1007/s13555-022-00693-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The aim of this study was to evaluate response and drug survival of biologic therapy in patients with moderate to severe plaque-type psoriasis who initiated biologic therapy at least 10 years ago, in a real-world setting. Methods This was an observational retrospective follow-up study that included patients with moderate to severe plaque-type psoriasis who initiated biologic therapy between October 2006 and December 2009. Efficacy was expressed as the percentage of patients achieving a 50, 75 and 90% reduction from baseline in the Psoriasis Area and Severity Index (PASI 50, PASI 75, PASI 90, respectively) every 3 months during the first year of therapy and then every 12 months up to the end of follow-up or withdrawal from the study. Results A total of 56 patients were included in the study, representing 140 treatment lines (median 2, range 1–8); of these patients, 53 were still receiving biologic therapy at the end of the study. The mean duration of biologic therapy was 140.4 (range 47.6–175.4) months. Etanercept was used in 98.2% of patients, followed by efalizumab (42.9%), adalimumab (41.1%), ustekinumab (33.9%) and infliximab (16.1%). Treatment lines were switched in 62.1% of treatments: 24.3% due to secondary failure, 20.7% due to primary failure and 3.6% due to side effects. No patient treated with anti-interleukins had to discontinue treatment due to side effects. Ustekinumab had the highest drug survival. Conclusions This study in the real-world-setting shows maintenance of long-term efficacy and safety of biologic therapy in patients with moderate to severe plaque psoriasis in daily practice who initiated biologic therapy 10 years ago.
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Affiliation(s)
- Laida Elberdín
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), As Xubias, 84, 15006, A Coruña, Spain.
| | - Rosa M Fernández-Torres
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas,Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Sabela Paradela
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas,Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - María Mateos
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), As Xubias, 84, 15006, A Coruña, Spain
| | - Eva Blanco
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas,Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - María I Gómez-Besteiro
- Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Maria Outeda
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), As Xubias, 84, 15006, A Coruña, Spain
| | - Isabel Martín-Herranz
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), As Xubias, 84, 15006, A Coruña, Spain
| | - Eduardo Fonseca
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas,Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
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Akdogan N, Dogan S, Bostan E, Gulseren D, Yalici-Armagan B, Elcin G, Evans SE, Karaduman A, Atakan N. Age and psoriatic arthritis are important predictors of biologic agent switch in psoriasis. Expert Rev Clin Pharmacol 2021; 14:1535-1541. [PMID: 34519227 DOI: 10.1080/17512433.2021.1979394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The demand of biologic switching is increasing for different reasons.We aimed to define reasons for switching biologics and possible predictors for switching risk,and to estimate data on drug survival. METHODS 115 patients treated with biologics who switched to a second, third,and/or fourth biologic were eligible for this retrospective study.Patients were divided into 2 groups as switched once,and switched twice or more.Drug survival rates were calculated using the Kaplan-Meier method. RESULTS All patients switched at least one, 36 patients switched twice, and 9 switched thrice. First-, second-, and third-line biologics were mostly switched due to secondary lack of efficacy for skin disease.Each unit increase in age decreased the risk of having ≥2 switches 4% (p=0.038,OR:0.964,95%CI:0.93-0.998),whereas PsA increased the risk of having ≥2 switches 2.69-fold (p=0.026,OR:2.69,95%CI:1.12-6.44).There was significant difference between biologics in terms of drug survival(p=0.001).Adalimumab had a lower drug survival compared to ustekinumab(p<0.001) and secukinumab(p=0.003) in transition from second-line biologic to third-line biologic. CONCLUSION Switching biologics was most commonly due to secondary lack of efficacy for skin disease.Lower ages and the presence of PsA were associated with a higher need for switching in long-term.Ustekinumab and secukinumab are superior to adalimumab in clinical practice in terms of drug survival of second-line biologics.
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Affiliation(s)
- Neslihan Akdogan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Dogan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ecem Bostan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Duygu Gulseren
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Basak Yalici-Armagan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Gonca Elcin
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Ersoy Evans
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Aysen Karaduman
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Nilgun Atakan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
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Meijboom RW, Gardarsdottir H, Becker ML, de Groot MCH, Movig KLL, Kuijvenhoven J, Egberts TCG, Leufkens HGM, Giezen TJ. Switching TNFα inhibitors: Patterns and determinants. Pharmacol Res Perspect 2021; 9:e00843. [PMID: 34302442 PMCID: PMC8305431 DOI: 10.1002/prp2.843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to assess switching patterns and determinants for switching in patients initiating TNFα inhibitor (TNFα-i) treatment. Patients were included who started TNFα-i treatment between July 1, 2012 and December 31, 2017, from three Dutch hospitals, and were diagnosed with rheumatic diseases (RD), inflammatory bowel disease (IBD), or psoriasis. Outcomes were switching, defined as initiating another biological; switching patterns including multiple switches until the end of follow-up; determinants for first switch, assessed using multivariate logistic regression. A total of 2228 patients were included (median age 43.3 years, 57% female), of which 52% (n = 1155) received TNFα-i for RD, 43% (n = 967) for IBD, and 5% (n = 106) for psoriasis. About 16.6% of RD patients, 14.5% of IBD patients, and 16.0% of psoriasis patients switched at least once, mainly to another TNFα-i. TNFα-i dose escalation (OR 13.78, 95% CI 1.40-135.0) and high-dose corticosteroids initiation (OR 3.62, 95% CI 1.10-12.15) were determinants for switching in RD patients. TNFα-i dose escalation (OR 8.22, 95% CI 3.76-17.93), immunomodulator initiation/dose escalation (OR 2.13, 95% CI 1.04-4.34), high-dose corticosteroids initiation (OR 6.91, 95% CI 2.81-17.01) and serum concentration measurement (OR 5.44, 95% CI 2.74-10.79) were determinants for switching in IBD patients. Switching biological treatment occurred in about one in six patients. RD patients with TNFα-i dose escalation and/or high-dose corticosteroids initiation were more likely to switch. IBD patients with TNFα-i or immunomodulator initiation/dose escalation, high-dose corticosteroids initiation or serum concentration measurement were more likely to switch. These findings might help clinicians anticipating switching in TNFα-i treatment.
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Affiliation(s)
- Rosanne W. Meijboom
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Department of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
| | - Matthijs L. Becker
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
| | - Mark C. H. de Groot
- Central Diagnostic LaboratoryDivision Laboratories, Pharmacy and Biomedical GeneticsUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Kris L. L. Movig
- Department of Clinical PharmacyMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Johan Kuijvenhoven
- Department of Gastroenterology and HepatologySpaarne Gasthuis, Haarlem and HoofddorpThe Netherlands
| | - Toine C. G. Egberts
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Thijs J. Giezen
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
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6
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Lambert JLW, Segaert S, Ghislain PD, Hillary T, Nikkels A, Willaert F, Lambert J, Speeckaert R. Practical recommendations for systemic treatment in psoriasis according to age, pregnancy, metabolic syndrome, mental health, psoriasis subtype and treatment history (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis; part 1). J Eur Acad Dermatol Venereol 2021; 34:1654-1665. [PMID: 32735076 PMCID: PMC7496083 DOI: 10.1111/jdv.16684] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
Background Impressive progress in new therapeutic options has been made for psoriasis. Treatments include topical steroids, phototherapy, conventional, synthetic disease‐modifying drugs and an expanding list of biologics. Objective The primary objective of this work was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis). Methods Evidence‐based recommendations were formulated using a quasi‐Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts. Results In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed. Conclusion Guidance on therapeutic choice in specific clinical situations in psoriasis is provided in order to facilitate the decision‐making in clinical practice.
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Affiliation(s)
- J L W Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - P D Ghislain
- Dermatology, Cliniques Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - T Hillary
- Dermatology, University Hospital Leuven, Leuven, Belgium
| | - A Nikkels
- Dermatology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - F Willaert
- Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - J Lambert
- Dermatology, University Hospital of Antwerp, Antwerp, Belgium
| | - R Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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7
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Geale K, Lindberg I, Paulsson EC, Wennerström ECM, Tjärnlund A, Noel W, Enkusson D, Theander E. Persistence of biologic treatments in psoriatic arthritis: a population-based study in Sweden. Rheumatol Adv Pract 2021; 4:rkaa070. [PMID: 33409449 PMCID: PMC7772250 DOI: 10.1093/rap/rkaa070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives TNF inhibitors (TNFis) and IL inhibitors are effective treatments for PsA. Treatment non-persistence (drug survival, discontinuation) is a measure of effectiveness, tolerability and patient satisfaction or preferences in real-world clinical practice. Persistence on these treatments is not well understood in European PsA populations. The aim of this study was to compare time to non-persistence for either ustekinumab (IL-12/23 inhibitor) or secukinumab (IL-17 inhibitor) to a reference group of adalimumab (TNFi) treatment exposures in PsA patients and identify risk factors for non-persistence. Methods A total of 4649 exposures of adalimumab, ustekinumab, and secukinumab in 3918 PsA patients were identified in Swedish longitudinal population-based registry data. Kaplan–Meier curves were constructed to measure treatment-specific real-world risk of non-persistence and adjusted Cox proportional hazards models were estimated to identify risk factors associated with non-persistence. Results Ustekinumab was associated with a lower risk of non-persistence relative to adalimumab in biologic-naïve [hazard ratio (HR) 0.48 (95% CI 0.33, 0.69)] and biologic-experienced patients [HR 0.65 (95% CI 0.56, 0.76)], while secukinumab was associated with a lower risk in biologic-naïve patients [HR 0.65 (95% CI 0.49, 0.86)] but a higher risk of non-persistence in biologic-experienced patients [HR 1.20 (95% CI 1.03, 1.40)]. Biologic non-persistence was also associated with female sex, axial involvement, recent disease onset, biologic treatment experience and no psoriasis. Conclusion Ustekinumab exhibits a favourable treatment persistency profile relative to adalimumab overall and across lines of treatment. The performance of secukinumab is dependent on biologic experience. Persistence and risk factors for non-persistence should be accounted for when determining an optimal treatment plan for patients.
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Affiliation(s)
- Kirk Geale
- Quantify Research, Stockholm, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - E Christina M Wennerström
- Janssen-Cilag AB, Solna, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Wim Noel
- Janssen Pharmaceutica NV, Beerse, Belgium
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8
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Graier T, Salmhofer W, Jonak C, Weger W, Kölli C, Gruber B, Sator PG, Prillinger K, Mlynek A, Schütz-Bergmayr M, Richter L, Ratzinger G, Painsi C, Selhofer S, Häring N, Wippel-Slupetzky K, Skvara H, Trattner H, Tanew A, Inzinger M, Tatarski R, Bangert C, Ellersdorfer C, Lichem R, Gruber-Wackernagel A, Hofer A, Legat F, Schmiedberger E, Strohal R, Lange-Asschenfeldt B, Schmuth M, Vujic I, Hoetzenecker W, Trautinger F, Saxinger W, Müllegger R, Quehenberger F, Wolf P. Biologic drug survival rates in the era of anti-interleukin-17 antibodies: a time-period-adjusted registry analysis. Br J Dermatol 2020; 184:1094-1105. [PMID: 33289075 PMCID: PMC8248155 DOI: 10.1111/bjd.19701] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/22/2022]
Abstract
Background Drug survival rates reflect efficacy and safety and may be influenced by the availability of alternative treatment options. Little is known about time‐dependent drug survival in psoriasis and the effect of increasing numbers of biologic treatment options. Objectives To determine whether drug survival is influenced by the availability of treatment options and by factors such as gender, psoriatic arthritis or previous biologic treatment. Methods This observational, retrospective, multicentre cohort study analysed data from patients registered in the Austrian Psoriasis Registry (PsoRA) who were treated with biologics between 1 January 2015 and 30 November 2019. Results A total of 1572 patients who received 1848 treatment cycles were included in this analysis. The highest long‐term Psoriasis Area and Severity Index improvement was observed after treatment with ixekizumab, followed by ustekinumab and secukinumab, adalimumab and etanercept. Overall, ustekinumab surpassed all other biologics in drug survival up to 48 months. However, when adjusted for biologic naïvety, its superiority vanished and drug survival rates were similar for ixekizumab (91·6%), secukinumab (90·2%) and ustekinumab (92·8%), all of them superior to adalimumab (76·5%) and etanercept (71·9%) at 12 months and beyond. Besides biologic non‐naïvety (2·10, P < 0·001), the introduction of a new drug such as secukinumab or ixekizumab (relative hazard ratio 1·6, P = 0·001) and female gender (1·50, P = 0·019) increased the risk of treatment discontinuation overall, whereas psoriatic arthritis did not (1·12, P = 0·21). Conclusions The time‐dependent availability of drugs should be considered when analysing and comparing drug survival. Previous biologic exposure significantly influences drug survival. Women are more likely to stop treatment.
What is already known about this topic?
Female gender and previous biologic exposure have been discussed as predictors for decreased drug survival in patients with psoriasis, but it remains unknown whether a time‐dependent increased availability of treatment options alters biologic drug survival.
What does this study add?
The increased availability of alternative biologic treatments over time leads to an elevated risk for treatment discontinuation overall; therefore, drug survival analysis has to be time adjusted. Moreover, the study reveals that the impact of previous biologic treatment on drug survival is tremendous and confirms worse drug survival in female patients.
Linked Comment: Gniadecki. Br J Dermatol 2021; 184:996–997.
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Affiliation(s)
- T Graier
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - W Salmhofer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - W Weger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - C Kölli
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - B Gruber
- Department of Dermatology and Venereology, Hospital of Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - P G Sator
- Department of Dermatology, Hietzing Hospital, Vienna, Austria
| | - K Prillinger
- Department of Dermatology and Venereology, University Hospital St Pölten, St Pölten, Austria
| | - A Mlynek
- Department of Dermatology, Hospital of Elisabethinen, Linz, Austria
| | - M Schütz-Bergmayr
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| | - L Richter
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - G Ratzinger
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Painsi
- Department of Dermatology and Venereology, State Hospital, Klagenfurt, Austria
| | - S Selhofer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - N Häring
- Department of Dermatology and Venereology, Federal Academic Teaching Hospital, Feldkirch, Austria
| | | | - H Skvara
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - H Trattner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Inzinger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - R Tatarski
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - C Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Ellersdorfer
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - R Lichem
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Gruber-Wackernagel
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Hofer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - F Legat
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - E Schmiedberger
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - R Strohal
- Department of Dermatology and Venereology, Federal Academic Teaching Hospital, Feldkirch, Austria
| | | | - M Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - I Vujic
- Department of Dermatology and Venereology, State Hospital of Vienna Rudolfstiftung, Vienna, Austria
| | - W Hoetzenecker
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| | - F Trautinger
- Department of Dermatology and Venereology, University Hospital St Pölten, St Pölten, Austria
| | - W Saxinger
- Department of Dermatology and Venereology, Hospital of Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - R Müllegger
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - P Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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