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.
Authors
Richard B. Warren
Mark Lunt
Dr Kayleigh Mason k.mason@keele.ac.uk
Ian Evans
Kathleen McElhone
Catherine H. Smith
Nick J. Reynolds
Darren M. Ashcroft
Christopher E.M. Griffiths
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.
Citation
Iskandar, I. Y., Warren, R. B., Lunt, M., Mason, K. J., Evans, I., McElhone, K., …Griffiths, C. E. (2018). 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). Journal of Investigative Dermatology, 138(4), 775 - 784. https://doi.org/10.1016/j.jid.2017.09.044
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 |
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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
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