Biologic drug survival rates in the era of anti‐interleukin‐17 antibodies: a time‐period‐adjusted registry analysis*

Abstract

Summary Background Drug survival rates reflect efficacy and safety and may be influenced by the availability of alternative treatment options. Little is known about time‐dependent drug survival in psoriasis and the effect of increasing numbers of biologic treatment options. Objectives To determine whether drug survival is influenced by the availability of treatment options and by factors such as gender, psoriatic arthritis or previous biologic treatment. Methods This observational, retrospective, multicentre cohort study analysed data from patients registered in the Austrian Psoriasis Registry (PsoRA) who were treated with biologics between 1 January 2015 and 30 November 2019. Results A total of 1572 patients who received 1848 treatment cycles were included in this analysis. The highest long‐term Psoriasis Area and Severity Index improvement was observed after treatment with ixekizumab, followed by ustekinumab and secukinumab, adalimumab and etanercept. Overall, ustekinumab surpassed all other biologics in drug survival up to 48 months. However, when adjusted for biologic naïvety, its superiority vanished and drug survival rates were similar for ixekizumab (91·6%), secukinumab (90·2%) and ustekinumab (92·8%), all of them superior to adalimumab (76·5%) and etanercept (71·9%) at 12 months and beyond. Besides biologic non‐naïvety (2·10, P < 0·001), the introduction of a new drug such as secukinumab or ixekizumab (relative hazard ratio 1·6, P = 0·001) and female gender (1·50, P = 0·019) increased the risk of treatment discontinuation overall, whereas psoriatic arthritis did not (1·12, P = 0·21). Conclusions The time‐dependent availability of drugs should be considered when analysing and comparing drug survival. Previous biologic exposure significantly influences drug survival. Women are more likely to stop treatment.

Multicenter Retrospective Study of Secukinumab Drug Survival in Psoriasis Patients in a Daily Practice Setting: A Long-Term Experience in Spain

“…Secukinumab (SEC) is a fully human monoclonal IgG1/j isotype antibody that selectively binds to and neutralizes interleukin 17A (IL-17A), a proinflammatory cytokine with key involvement in the clinical manifestation of psoriasis [1]. Despite its high effectiveness and safety profile demonstrated in the treatment of moderateto-severe plaque psoriasis, there is limited and conflicting evidence over the real-world drug survival of secukinumab in patients with psoriasis [2][3][4][5][6][7][8][9][10][11][12][13][14][15], especially in the long term [16][17][18]. Moreover, there is also a great variability in the results related to the predictors of a greater or lesser survival.…”

The ecological approach to biologic drugs: survival of the fittest

“…An example of such a real‐world study is the article by Graier et al . in this issue of the BJD 1 . Using data from the Austrian Psoriasis Registry (PsoRA) the authors examined the so‐called drug survival rates of different biologics used in the treatment of psoriasis.…”

“…The utility of the drug is not an absolute, immutable attribute of the medication, but it co‐evolves with the environment in which it is used. Graier et al 1 . have highlighted the importance of the availability of alternative treatments but other factors are also likely to play a role, such as drug accessibility, regulations regarding its use, reimbursement landscape, advertising and influence from the leaders in the field.…”

“…Each term implies the other. The article by Graier et al 1 . reminds us that we should consider the physician, the patient and the drug as complementary, reciprocally interacting components of the evolving meaningful environment.…”

“…The authors found that the drug survival rates are heavily influenced by the availability of alternative treatment options. For example, the introduction of the second‐generation biologics (secukinumab or ixekizumab) increased the risk of treatment discontinuation at the strength comparable to other known risk factors for treatment cessation, such as failure of the previous biologic, female sex or obesity (hazard ratio 1·6) 1,3,4,6 …”