Background Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients' adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis-ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab-and to identify clinical predictors that can influence the drug survival of these drugs. Methods This retrospective multicentric cohort study from 16 dermatology centers in Portugal,

Long-term (≥12 months) treatment with a TNF-α inhibitor, but not methotrexate and ustekinumab, may increase risk for malignancy in patients with psoriasis.

To the Editor: Secukinumab, an interleukin 17A inhibitor approved for the treatment of moderate-tosevere plaque psoriasis, has shown high levels of clinical efficacy and a favorable safety profile in both short-term and long-term clinical trials. However, in some studies in the real-life setting, secukinumab showed a 73%-78% drug survival at 12 months, shorter than that of other biologic agents, even among biologic-naive patients, and loss of effectiveness was the most common reason for discontinuation. 1-4 To evaluate drug survival of secukinumab in a daily practice setting, we retrospectively evaluated all psoriatic patients starting secukinumab during January 2016-February 2017 at 11 centers in 3 European countries and followed them until February 2018 (potentially with at least 1 year of observation period). Failure was defined as stopping secukinumab definitively or switching to a different therapy. Drug survival was analyzed using KaplaneMeier methodology. A total of 330 patients were included. Their median 6 standard deviation age was 51.9 6 14.6 years, 68% were male, and 19.6% were obese (body mass index [BMI] $30 kg/m 2); 21.5% of patients had a diagnosis of psoriatic arthritis, and 52.4% were biologic-experienced (24.5% with $2 prior biologics). All patients were treated with the 300-mg label dose, and there was no dose adjustment throughout the treatment. Concomitant systemic therapy was used in 12% of patients (mostly methotrexate). Overall drug survival of secukinumab was 83% after 12 months and 78.8% after 18 months (Fig 1, A). The dropout rate at 18 months was 20%: 12.4% of patients were lost to follow-up, 6.7% of patients stopped because of drug ineffectiveness, 0.3% of patients discontinued because of adverse events, and 0.6% of patients decided to quit the drug. Drug survival rates at 12 and 18 months were lower for biologic-experienced than biologic-naive patients (Fig 1, B) and lower in obese than nonobese patients. Patients treated with concomitant systemic therapies also showed a lower drug survival rate than those treated with secukinumab monotherapy at 12 months (79.5% vs 94.2%, respectively) and 18 months (53.7% vs 81.8%, respectively). Univariate Cox regression analysis of drug survival determinants showed that prior use of [1

Background Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. ConclusionThe cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, an...

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