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Pinter A, Costanzo A, Khattri S, Smith SD, Carrascosa JM, Tada Y, Riedl E, Reich A, Brnabic A, Haustrup N, Lampropoulou A, Lipkovich I, Kadziola Z, Paul C, Schuster C. Comparative Effectiveness and Durability of Biologics in Clinical Practice: Month 12 Outcomes from the International, Observational Psoriasis Study of Health Outcomes (PSoHO). Dermatol Ther (Heidelb) 2024; 14:1479-1493. [PMID: 38113010 PMCID: PMC11169432 DOI: 10.1007/s13555-023-01086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Given the chronic nature of psoriasis (PsO), more studies are needed that directly compare the effectiveness of different biologics over long observation periods. This study compares the effectiveness and durability through 12 months of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis in a real-world setting. METHODS The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year, prospective, non-interventional cohort study of 1981 adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. The study compares the effectiveness of anti-IL-17A biologics with other approved biologics and provides pairwise comparisons of seven individual biologics versus ixekizumab. The primary outcome was defined as the proportion of patients who had at least a 90% improvement in Psoriasis Area and Severity Index score (PASI90) and/or a score of 0 or 1 in static Physician Global Assessment (sPGA). Secondary objective comparisons included the proportion of patients who achieved PASI90, PASI100, a Dermatology Life Quality Index (DLQI) score of 0 or 1, and three different measures of durability of treatment response. Unadjusted response rates are presented alongside the primary analysis, which uses frequentist model averaging (FMA) to evaluate the adjusted comparative effectiveness. RESULTS Compared to the other biologics cohort, the anti-IL-17A cohort had a higher response rate (68.0% vs. 65.1%) and significantly higher odds of achieving the primary outcome at month 12. The two cohorts had similar response rates for PASI100 (40.5% and 37.1%) and PASI90 (53.9% and 51.7%) at month 12, with no significant differences between the cohorts in the adjusted analyses. At month 12, the response rates across the individual biologics were 53.5-72.6% for the primary outcome, 27.6-48.3% for PASI100, and 41.7-61.4% for PASI90. CONCLUSIONS These results show the comparative effectiveness of biologics at 6 and 12 months in the real-world setting.
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Affiliation(s)
- A Pinter
- University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - A Costanzo
- Division of Dermatology, Humanitas Research Hospital, Pieve Emanuele, Milan, Italy
- Dermatology IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - S Khattri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - J M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma of Barcelona, IGTP, Carretera de Canyet, S/N, 08916, Badalona, Barcelona, Spain
| | - Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - E Riedl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - A Brnabic
- Eli Lilly and Company, Indianapolis, USA
| | - N Haustrup
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - Z Kadziola
- Eli Lilly and Company, Indianapolis, USA
| | - C Paul
- Université Paul Sabatier Toulouse III, Toulouse, France
| | - C Schuster
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Eli Lilly and Company, Indianapolis, USA
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Armstrong AW, Warren RB, Zhong Y, Zhuo J, Cichewicz A, Kadambi A, Junqueira D, Westley T, Kisa R, Daamen C, Augustin M. Short-, Mid-, and Long-Term Efficacy of Deucravacitinib Versus Biologics and Nonbiologics for Plaque Psoriasis: A Network Meta-Analysis. Dermatol Ther (Heidelb) 2023; 13:2839-2857. [PMID: 37801281 PMCID: PMC10613195 DOI: 10.1007/s13555-023-01034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Deucravacitinib, a newly approved oral medication for the treatment of patients with moderate to severe plaque psoriasis, demonstrated efficacy versus apremilast and placebo in two phase 3 randomized controlled trials (RCTs). A systematic review and network meta-analysis (NMA) indirectly compared deucravacitinib with other relevant systemic biologic/nonbiologic treatments. METHODS Online databases were searched for RCTs published through October 2021. Eligible studies were head-to-head comparisons between systemic therapies and/or placebo reporting 50%, 75%, 90%, or 100% improvement in Psoriasis Area and Severity Index (PASI) from baseline in adults with moderate to severe plaque psoriasis. Comparisons included tumor necrosis factor inhibitors, interleukin (IL)-17, IL-23, and IL 12/23 inhibitors, and systemic nonbiologics. A multinomial Bayesian NMA was used to derive estimates of the relative efficacy of deucravacitinib and other systemic therapies. Response probabilities for each treatment and corresponding 95% credible intervals (CrIs) for achieving a PASI response were calculated over short-, mid-, and long-term follow-up (weeks 10-16, 24-28, and 44-60). RESULTS The NMA included 47 RCTs. Deucravacitinib showed the highest PASI 75 response rates among nonbiologic systemic therapies across time points. Deucravacitinib PASI 75 response rate (95% CrI) over short-term follow-up was 54.1% (46.5-61.6), within the range of first-generation biologics (etanercept, 39.7% [31.6-48.3]; infliximab, 79.0% [74.0-83.5]). At mid-term follow-up, deucravacitinib PASI 75 increased to 63.3% (58.0-68.4). At long-term follow-up, deucravacitinib PASI 75 was 65.9% (58.0-73.4), comparable to first-generation biologics adalimumab (62.8%; 55.3-69.6) and ustekinumab (68.0%; 64.6-71.5). CONCLUSIONS Patients receiving deucravacitinib were more likely to achieve PASI 75 response versus apremilast and methotrexate across all time points. The long-term PASI 75 response rate for deucravacitinib was similar to those of adalimumab and ustekinumab. The approval of deucravacitinib offers patients the choice of an oral therapy with long-term efficacy similar to that of some biologics.
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Affiliation(s)
- April W Armstrong
- University of California Los Angeles, Los Angeles, CA, USA.
- Division of Dermatology, David Geffen Department of Medicine, University of California Los Angeles, 2001 Santa Monica Boulevard, Suite 1090, Santa Monica, CA, 90404, USA.
| | - Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Joe Zhuo
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Allie Cichewicz
- Evidera, a part of Thermo Fisher Scientific, Waltham, MA, USA
| | - Ananth Kadambi
- Evidera, a part of Thermo Fisher Scientific, Waltham, MA, USA
| | | | - Tracy Westley
- Evidera, a part of Thermo Fisher Scientific, Waltham, MA, USA
- Lumanity, Sheffield, UK
| | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center, Hamburg, Germany
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Augustin M, Schuster C, Mert C, Nast A. The Value of Indirect Comparisons of Systemic Biologics for Psoriasis: Interpretation of Efficacy Findings. Dermatol Ther (Heidelb) 2022; 12:1711-1727. [PMID: 35834062 PMCID: PMC9357597 DOI: 10.1007/s13555-022-00765-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION It can be challenging for dermatologists to keep abreast of the growing evidence from published indirect comparisons (ICs) of treatments for psoriasis. The objective of this analysis was to summarise comparative clinical efficacy and safety findings from ICs of systemic biologics for the treatment of moderate-to-severe psoriasis and to identify factors potentially affecting efficacy outcomes and their possible implications for clinical decision making. METHODS An umbrella review of short- and long-term efficacy and safety findings from 26 ICs visually compared 90% improvement in Psoriasis Area Severity Index (PASI90) treatment rankings and three safety outcome rankings side by side. Pearson's correlation coefficients measured the strength of the association between each pair of ICs on the basis of identified factors that could potentially affect efficacy findings. RESULTS Some consistency in short-term PASI90 efficacy rankings was observed for certain drugs, although rankings for most drugs varied by IC. Factors potentially affecting efficacy outcomes included the use of different methodologies for head-to-head comparison and statistical analyses, and variation in drugs and classes included treatment dosing and duration, outcome definitions and effect measures reported between ICs. Considerable variation in these factors was found across all 26 ICs. Comparative safety information of value to physicians was limited. CONCLUSIONS Substantial differences were identified between ICs in factors that could potentially affect efficacy outcomes. Treatment rankings must be interpreted alongside actual differences in IC outcomes to allow conclusions on clinical relevance. Drugs within a class cannot be considered of equal efficacy: therapies should be considered individually rather than by class.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | | | - Can Mert
- HaaPACS GmbH, Schriesheim, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine, Department of Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Pinter A, Puig L, Schäkel K, Reich A, Zaheri S, Costanzo A, Tsai TF, Smith SD, Lynde C, Brnabic A, Reed C, Hill J, Schuster C, Riedl E, Paul C. Comparative Effectiveness of Biologics in Clinical Practice: Week 12 Primary Outcomes from an International Observational Psoriasis Study of Health Outcomes (PSoHO). J Eur Acad Dermatol Venereol 2022; 36:2087-2100. [PMID: 35766124 DOI: 10.1111/jdv.18376] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical trials study treatment outcomes under stringent conditions, capturing incompletely the heterogeneity of patient populations and treatment complexities encountered in real-world practice. OBJECTIVES To compare the effectiveness of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis. METHODS The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year observational cohort study in adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. Primary study endpoint is proportion of patients achieving 90% improvement in Psoriasis Area and Severity Index (PASI 90) and/or static Physician Global Assessment (sPGA) 0/1 at Week 12 (W12) in the anti-IL-17A cohort (ixekizumab [IXE], secukinumab) versus all other approved biologics. Secondary outcomes include proportion of patients who achieve PASI 75/90/100, absolute PASI scores ≤5, ≤2 and ≤1, Dermatology Life Quality Index (DLQI) score of 0/1 at W12 between the two cohorts and among the individual biologics. Comparative effectiveness analyses were conducted using Frequentist Model Averaging (FMA), a novel causal inference machine learning approach. Missing data for binary outcomes were imputed as non-response. RESULTS Patient profiles in the anti-IL-17A cohort and other biologics cohort were similar, with more frequent comorbid psoriatic arthritis and less frequent exposure to conventional treatments in the patients receiving anti-IL17A biologics. At W12, 71.4% of patients who received an anti-IL-17A biologic achieved PASI 90 and/or sPGA 0/1 compared to 58.6% of patients who received other biologics (odds ratios [OR], 1.9; 95% confidence intervals [CI], [1.6, 2.4]). Similar findings were observed for secondary outcomes. CONCLUSIONS These results reflect the high efficacy and early onset of skin clearance of IL-17A inhibitors observed in randomized clinical trials and confirm the effectiveness of anti-IL17A biologics in the real-world setting.
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Affiliation(s)
- Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Knut Schäkel
- Department of Dermatology, University Hospital, Heidelberg, Germany
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Shirin Zaheri
- Department of Dermatology, Imperial College Healthcare NHS Trust, London, England
| | - Antonio Costanzo
- Division of Dermatology, Humanitas Research Hospital, Pieve Emanuele, Milan, Italy.,Dermatology IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Tsen Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Charles Lynde
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alan Brnabic
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Julie Hill
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Christopher Schuster
- Eli Lilly and Company, Indianapolis, Indiana, USA.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Riedl
- Eli Lilly and Company, Indianapolis, Indiana, USA.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Carle Paul
- Paul Sabatier University and Larrey Hospital, Toulouse, France
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