Drug survival and clinical effectiveness of secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, tildrakizumab for psoriasis treatment

Abstract

SummaryBackgroundBiologics targeting IL‐23 and IL‐17 show efficacy and safety in the treatment of moderate‐to‐severe psoriasis.ObjectiveTo investigate drug survival in patients with psoriasis treated with biologics.Patients and methodsWe performed a comparative evaluation of the achievement of PASI 90 and PASI ≤ 3 at 16, 28, and 52 weeks along with a DS (drug survival) analysis with IL‐17 and IL‐23 inhibitors brodalumab, ixekizumab, secukinumab, risankizumab, tildrakizumab, and guselkumab on 1,057 patients.ResultsIL‐17 inhibitors showed a faster achievement of PASI 90 and PASI ≤ 3 with significant superiority over IL‐23 inhibitors at week 16 (p < 0.001; 56% vs. 42% and 70% vs. 59%, respectively). A difference was shown in favor of IL‐23 inhibitors regarding DS (p < 0.001), which was 88% at 24 months vs. 75% for IL‐17 inhibitors. In multivariate analysis, IL‐23 inhibitors (HR 0.54 CI 0.37–0.78, p = 0.001), and male sex (HR 0.57 CI 0.42–0.76, p < 0.001) were all associated with a lower probability of drug interruption. Risankizumab (HR 0.42 CI 0.26‐0.69, p = 0.001), guselkumab (HR 0.49 CI 0.24–0.99, p = 0.046), and male sex (HR 0.57 CI 0.43–0.77, p < 0.001) were associated with a lower probability of drug interruption than secukinumab.ConclusionsIL‐23 inhibitors showed the best performance on DS. Overall, the most effective class was IL‐17 inhibitors considering the short‐term effectiveness, but long‐term effectiveness is in favor of anti‐IL‐23.

Effectiveness and Safety of Biological Therapies in Very Severe Plaque Psoriasis: A Real-Life Retrospective Study

“…Extensive real-world evidence indicates that higher psoriasis severity is linked to lower HRQoL and increased impairments in work productivity [9,10]. This is also explained by the higher prevalence of comorbidities compared to the general population; severe psoriasis is associated with a significant increased risk of myocardial infarction, coronary artery disease, stroke, and cardiovascular mortality, as well as metabolic syndrome, type 2 diabetes mellitus, inflammatory bowel diseases, depression, anxiety, and suicidal ideation [2][3][4][5][6][7].…”

“…Psoriasis is a chronic inflammatory disease affecting 2-4% of the general population worldwide [1,2]. Plaque psoriasis, the predominant variant, accounting for over 80% of cases, is characterized by erythematous scaly patches or plaques, typically appearing on extensor surfaces but also affecting intertriginous areas, palms, soles, and nails.…”

“…Although, in most cases, the disease manifests on the skin, it is also associated with important comorbidities, including psoriatic arthritis, metabolic syndrome, cardiovascular diseases, inflammatory bowel diseases, type 2 diabetes mellitus, depression, and cancer [2,[4][5][6][7]. The Psoriasis Area and Severity Index (PASI) is a tool used to evaluate and categorize the severity of psoriatic lesions and their response to treatment; it divides the body into four regions, the head, trunk, upper extremities, and lower extremities, and each of these areas is individually examined to determine the percentage of involvement, resulting in a numerical score ranging from 0 (no involvement) to 6 (90% to 100% involvement).…”

“…Biologics are monoclonal antibodies targeting cytokines such as interleukin(IL)-17, IL-23, IL-12/23, and tumor necrosis factor-alpha (TNF-α); due to their great efficacy and tolerance, they are increasingly used for treating moderate-to-severe psoriasis when the patient does not tolerate the traditional systemic therapies due to adverse effects or inefficacy [4,13]. The great efficacy of biologics drives higher expectations and goals in the management of moderate-to-severe psoriasis; a ≥90% improvement in PASI (PASI90) or the achievement of absolute PASI ≤ 2 until 16 weeks of treatment are the current aims of treatment [2,15]. Yet, there is little evidence from clinical trials and observational open-label studies that highly severe psoriasis responds to biologics with the same effectiveness and rapidity as moderate-to-severe psoriasis.…”

“…Newer biological treatments have been associated with a reduced risk of several psoriatic comorbidities (e.g., type 2 diabetes mellitus, myocardial infarction, hypertension, and hyperlipidemia) and seem to improve the metabolic profile, leading from a pro-inflammatory to an anti-inflammatory phenotype [13,16,17]. In addition, they have demonstrated safety in special populations such as immunocompromised patients, cancer patients, and women with childbearing potential [1,2,18]. However, despite nearly two decades of biologics use in psoriatic disease, some dermatologists still harbor reservations regarding their long-term safety [12].…”