Differential Drug Survival of Second-Line Biologic Therapies in Patients with Psoriasis: Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).

Iskandar, Ireny Y.K.; Warren, Richard B.; Lunt, Mark; Mason, Kayleigh J.; Evans, Ian; McElhone, Kathleen; Smith, Catherine H.; Reynolds, Nick J.; Ashcroft, Darren M.; Griffiths, Christopher E.M.

Abstract

Little is known about the drug survival of second-line biologic therapies for psoriasis in routine clinical practice. We assessed drug survival of second-line biologic therapies and estimated the risk of recurrent discontinuation due to adverse events or ineffectiveness in patients with psoriasis who had failed a first biologic therapy and switched to a second in a large, multicenter pharmacovigilance registry (n = 1,239; adalimumab, n = 538; etanercept, n = 104; ustekinumab, n = 597). The overall drug survival rate in the first year after switching was 77% (95% confidence interval = 74-79%), falling to 58% (55-61%) in the third year. Female sex, multiple comorbidities, concomitant therapy with cyclosporine, and a high Psoriasis Area and Severity Index at switching to the second-line biologic therapy were predictors of overall discontinuation (multivariable Cox proportional hazard model). Compared to adalimumab, patients receiving etanercept were more likely to discontinue therapy (hazard ratio = 1.87, 95% confidence interval = 1.24-2.83), whereas patients receiving ustekinumab were more likely to persist (hazard ratio = 0.46; 95% confidence interval = 0.33-0.64). Discontinuation of the first biologic therapy because of adverse events was associated with an increased rate of second drug discontinuation because of adverse events (hazard ratio = 2.55; 95% confidence interval = 1.50-4.32). In conclusion, drug survival rates differed among biologic therapies and decreased over time; second-line discontinuation because of adverse events was more common among those who discontinued first-line treatment for this reason. The results of this study should support clinical decision making when choosing second-line biologic therapy for patients with psoriasis.

• Journal Article Type: Article
• Acceptance Date: Sep 22, 2017
• Online Publication Date: Oct 25, 2017
• Publication Date: 2018-04
• Journal: Journal of Investigative Dermatology
• Print ISSN: 0022-202X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 138
• Issue: 4
• Pages: 775 - 784
• DOI: https://doi.org/10.1016/j.jid.2017.09.044
• Publisher URL: https://www.jidonline.org/article/S0022-202X(17)33068-3/fulltext#articleInformation