Ireny Y.K. Iskandar
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.
Richard B. Warren
Dr Kayleigh Mason firstname.lastname@example.org
Catherine H. Smith
Nick J. Reynolds
Darren M. Ashcroft
Christopher E.M. Griffiths
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|
|Journal||Journal of Investigative Dermatology|
|Peer Reviewed||Peer Reviewed|
|Pages||775 - 784|
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